Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT786 | ME |
NPI | 1023094968 |
---|---|
Provider Name | Barry Butler |
First Address | Biddeford, ME 04005-9526 |
Second Address | Biddeford, ME 04005-9526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 09/10/2007 |