Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070.020217 | IL |
NPI | 1396166047 |
---|---|
Provider Name | Dr. Kyle Butzine |
First Address | Lake Mills, WI 53551-1724 |
Second Address | Melrose Park, IL 60160-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2013 |
Last Update Date | 26/12/2013 |