Provider Demographics
NPI:1962886242
Name:PUTA, BRITTANY MARIE (DPT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIE
Last Name:PUTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6444
Mailing Address - Country:US
Mailing Address - Phone:920-832-1657
Mailing Address - Fax:920-968-4153
Practice Address - Street 1:3300 W BREWSTER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6444
Practice Address - Country:US
Practice Address - Phone:920-832-1657
Practice Address - Fax:920-968-4153
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13132-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist