Individual
AMANDA JOELLE UTTECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 GENEVA PKWY, LAKE GENEVA, WI 53147-4594
(262) 249-3500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 249-3500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15599-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100222713
—
WI
01
—
15599-24
STATE OF WISCONSIN LICENSE
WI
Enumeration date
09/08/2021
Last updated
05/18/2023
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