Provider Demographics
NPI:1891906137
Name:BUTERA, JOHN (LMT PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BUTERA
Suffix:
Gender:F
Credentials:LMT PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8833
Mailing Address - Country:US
Mailing Address - Phone:719-687-7964
Mailing Address - Fax:719-687-8131
Practice Address - Street 1:559 E PIKES PEAK AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3657
Practice Address - Country:US
Practice Address - Phone:719-634-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist