Provider Demographics
NPI:1699926014
Name:SHUTES, ROBERT STEVEN (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:SHUTES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1676
Mailing Address - Country:US
Mailing Address - Phone:715-647-2401
Mailing Address - Fax:
Practice Address - Street 1:301 CHERRY AVE W
Practice Address - Street 2:
Practice Address - City:PLUM CITY
Practice Address - State:WI
Practice Address - Zip Code:54761-9781
Practice Address - Country:US
Practice Address - Phone:715-647-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2033-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist