Provider Demographics
NPI:1922573575
Name:BUTRON, RHEDEN MENDOZA (PT DPT)
Entity Type:Individual
Prefix:MR
First Name:RHEDEN
Middle Name:MENDOZA
Last Name:BUTRON
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 BUSHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4628
Mailing Address - Country:US
Mailing Address - Phone:347-369-7704
Mailing Address - Fax:
Practice Address - Street 1:585 BUSHWICK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4628
Practice Address - Country:US
Practice Address - Phone:347-369-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341771208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation