Provider Demographics
NPI:1811027485
Name:BUTTERS, KIM (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BUTTERS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELM CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8213
Mailing Address - Country:US
Mailing Address - Phone:505-550-4578
Mailing Address - Fax:505-891-4505
Practice Address - Street 1:117 ELM CT SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-8213
Practice Address - Country:US
Practice Address - Phone:505-550-4578
Practice Address - Fax:505-891-4505
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD3914Medicaid