Provider Demographics
NPI:1275604118
Name:BUTCH, MARY S (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:BUTCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2123
Mailing Address - Country:US
Mailing Address - Phone:412-366-3880
Mailing Address - Fax:412-366-7655
Practice Address - Street 1:1033 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2123
Practice Address - Country:US
Practice Address - Phone:412-366-3880
Practice Address - Fax:412-366-7655
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005448L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA561752OtherBLUE SHIELD PIN NUMBER
PA0745460000OtherHEALTH AMERICA PIN NUMBER
PA561758OtherBLUE SHIELD GROUP NUMBER
PA561752OtherBLUE SHIELD PIN NUMBER
PA023569MOUMedicare PIN