Active NPI
Justin R Putterman, DPT
- Physical Therapist
- Pewaukee, WI
National Provider Identifier
1720647399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14723
- Practice address
- 2835 N Grandview Blvd Ste 100
Pewaukee, WI 53072-5546 - Phone
- (262) 574-1100
- NPI assigned
- Jun 7, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 14723 | WI | Primary |
Addresses
Primary practice location
2835 N Grandview Blvd Ste 100
Pewaukee, WI 53072-5546
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559865600000",
"number": "1720647399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2222",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2835 N GRANDVIEW BLVD STE 100",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530725546",
"telephone_number": "262-574-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTTERMAN",
"first_name": "JUSTIN",
"middle_name": "R",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-07",
"last_updated": "2019-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.