Individual
SHELLY BUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-1390
Mailing address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-1390
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
126-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WISCONSIN LICENSE
126-019
WI
Enumeration date
05/18/2007
Last updated
07/08/2007
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