Provider Demographics
NPI:1316364979
Name:BUTTRICK, ROGER W (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:BUTTRICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 STONE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8996
Mailing Address - Country:US
Mailing Address - Phone:330-416-3356
Mailing Address - Fax:
Practice Address - Street 1:7533 STONE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8996
Practice Address - Country:US
Practice Address - Phone:330-416-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist