Provider Demographics
NPI:1316103708
Name:BOUTTE, DAWN MICHELLE (PT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELLE
Last Name:BOUTTE
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 1:2360 MONTEBELLO SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6977
Mailing Address - Country:US
Mailing Address - Phone:719-599-5330
Mailing Address - Fax:
Practice Address - Street 1:2360 MONTEBELLO SQUARE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6977
Practice Address - Country:US
Practice Address - Phone:719-599-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist