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NPI Code Detail

MEDICARE: BRIAN L BUTKIEWICZ PTA

MEDICARE: BRIAN L BUTKIEWICZ PTA
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
1225200000XPhysical Therapy Assistant777-019WI

General Provider Information

NPI Number : 1346461233
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN L BUTKIEWICZ PTA
Provider Business Mailing Address
First Line : 11651 WEST GRANGE AVE
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130
Country : US
Telephone Number : 414-529-2228
Fax Number :
Provider Business Practice Location Address
First Line : 6735 W BRADLEY RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-3325
Country : US
Telephone Number : 414-354-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 02/07/2014

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Directions to “ BRIAN L BUTKIEWICZ PTA” Practice Location

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