Provider Demographics
NPI:1881803740
Name:MAHLANDT-BUTTS, PATTI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:LYNN
Last Name:MAHLANDT-BUTTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8038 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6308
Mailing Address - Country:US
Mailing Address - Phone:262-653-0363
Mailing Address - Fax:
Practice Address - Street 1:1700 C A BECKER DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4714
Practice Address - Country:US
Practice Address - Phone:262-898-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI069-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant