MEDICARE: AMANDA M UTING 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	12491-24	WI
2	225100000X	Physical Therapist	005288	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005288	OTHER	IA	IOWA PT LICENSE

General Provider Information

NPI Number	:	1508294489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA M UTING DPT

Provider Business Mailing Address
First Line	:	850 43RD AVE STE 100
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-8401
Country	:	US
Telephone Number	:	309-743-2070
Fax Number	:	309-743-2073

Provider Business Practice Location Address
First Line	:	530 N 108TH PL STE 200
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4253
Country	:	US
Telephone Number	:	414-708-8066
Fax Number	:

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

Provider Enumeration Date	:	10/31/2013
Last Update Date	:	07/11/2023

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Directions to “ AMANDA M UTING DPT” Practice Location

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