Provider Demographics
NPI:1275755548
Name:BUTCHER, MICHAEL DOUGLAS SR (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BUTCHER
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:9429 CALIFORNIA OAK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363
Mailing Address - Country:US
Mailing Address - Phone:209-892-6485
Mailing Address - Fax:209-892-6485
Practice Address - Street 1:1500 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4408
Practice Address - Country:US
Practice Address - Phone:209-577-8570
Practice Address - Fax:209-572-0804
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist