Healthcare Provider Details

I. General information

NPI: 1801346218
Provider Name (Legal Business Name): NICHOLAS YEUTTER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S74W16775 JANESVILLE RD STE 120
MUSKEGO WI
53150-7742
US

IV. Provider business mailing address

13110 W WILBUR DR
NEW BERLIN WI
53151-5465
US

V. Phone/Fax

Practice location:
  • Phone: 414-422-2191
  • Fax: 414-422-2193
Mailing address:
  • Phone: 414-630-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13555-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: