Provider Demographics
NPI:1801406319
Name:BUTLER, RYAN JAMES (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAMES
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:JAMES
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:411 HUKU LII PL STE 101
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-879-0077
Mailing Address - Fax:808-879-0177
Practice Address - Street 1:40 KUPAOA ST # B-201
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-6215
Practice Address - Country:US
Practice Address - Phone:808-872-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28041225100000X
HI5210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist