Provider Demographics
NPI:1750410148
Name:BUTTKE, REBECCA (PT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BUTTKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22010 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4617
Mailing Address - Country:US
Mailing Address - Phone:763-420-2177
Mailing Address - Fax:
Practice Address - Street 1:14181 BUSINESS CENTER DR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4654
Practice Address - Country:US
Practice Address - Phone:763-236-0580
Practice Address - Fax:763-236-0585
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic