Healthcare Provider Details

I. General information

NPI: 1205442373
Provider Name (Legal Business Name): KOURTNEY BUELOW PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 UNIVERSITY AVE
MIDDLETON WI
53562-2764
US

IV. Provider business mailing address

105 CLARMAR DR
SUN PRAIRIE WI
53590-2675
US

V. Phone/Fax

Practice location:
  • Phone: 608-820-1300
  • Fax: 608-836-9672
Mailing address:
  • Phone: 608-318-5929
  • Fax: 608-318-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1518424
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15184-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: