Boutott, Jodi A

Boutott, Jodi A is an individual health care provider with primary practice located at 1625 E Main St , Clintonville WI 54929-8407. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Boutott, Jodi A can be contacted via phone (715) 823-3135.

Contact Information

Primary practice address
1625 E Main St Clintonville WI 54929-8407
Phone: (715) 823-3135
Fax: (715) 823-1313
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 5055-024 Wisconsin

Profile Details

NPI number 1184891590
LBN Legal business name Boutott, Jodi A
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 14th, 2008
Last updated Mar 27th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184891590 NPPES
Wisconsin MEDICAID 40296200

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