Provider Demographics
NPI:1760696348
Name:BUTEAU, SHARON L (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BUTEAU
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 1:115 WOODS END RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1933
Mailing Address - Country:US
Mailing Address - Phone:203-453-5712
Mailing Address - Fax:203-453-3610
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:MS 124-10
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-0968
Practice Address - Country:US
Practice Address - Phone:860-565-1089
Practice Address - Fax:860-565-6348
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist