Provider Demographics
NPI:1831708072
Name:PAUTSCH, ALYSSA MICHELE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELE
Last Name:PAUTSCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MICHELE
Other - Last Name:PATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:210 MILWAUKEE AVE W
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2022
Mailing Address - Country:US
Mailing Address - Phone:920-568-6580
Mailing Address - Fax:
Practice Address - Street 1:1461 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1568
Practice Address - Country:US
Practice Address - Phone:262-473-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15018-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist