MEDICARE: FRANK A BOUTIETTE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3524-24	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932230208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK A BOUTIETTE PT, DPT

Provider Business Mailing Address
First Line	:	24014 W RENWICK RD UNIT 206
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60544-8711
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Provider Business Practice Location Address
First Line	:	2751 COMMERCIAL BLVD STE 5
Second Line	:
City	:	LAKE HALLIE
State	:	WI
Zip	:	54729-5080
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	10/06/2024

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