Provider Demographics
NPI:1013961341
Name:BUTLER, MARK WILLIAM (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINE CONE TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9166
Mailing Address - Country:US
Mailing Address - Phone:609-953-7005
Mailing Address - Fax:
Practice Address - Street 1:128 ROUTE 70
Practice Address - Street 2:SUITE 2C
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2371
Practice Address - Country:US
Practice Address - Phone:609-953-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA004531002251X0800X
PAPT0301262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic