Provider Demographics
NPI:1891768297
Name:BUTT, KATHLEEN CALLAHAN (PT ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CALLAHAN
Last Name:BUTT
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT ATC
Mailing Address - Street 1:26 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904
Mailing Address - Country:US
Mailing Address - Phone:781-595-3474
Mailing Address - Fax:
Practice Address - Street 1:505 PARADISE ROAD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:781-586-0550
Practice Address - Fax:781-586-0125
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69563Medicare ID - Type Unspecified