Provider Demographics
NPI:1376967117
Name:BUTLER, ROLAND T JR (PT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:T
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 HARBOR VIEW BLVD
Mailing Address - Street 2:100
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3015
Mailing Address - Country:US
Mailing Address - Phone:757-686-0205
Mailing Address - Fax:
Practice Address - Street 1:5859 HARBOR VIEW BLVD
Practice Address - Street 2:100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3015
Practice Address - Country:US
Practice Address - Phone:757-686-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052048862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic