Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA00453100 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT030126 | PA |
NPI | 1013961341 |
---|---|
Provider Name | Mark William Butler |
First Address | Medford, NJ 08055-9166 |
Second Address | Medford, NJ 08055-2371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 31/01/2022 |