Provider Demographics
NPI:1023094968
Name:BUTLER, BARRY (PT)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HILLS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9526
Mailing Address - Country:US
Mailing Address - Phone:207-284-8650
Mailing Address - Fax:207-602-5929
Practice Address - Street 1:11 HILLS BEACH RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9526
Practice Address - Country:US
Practice Address - Phone:207-284-8650
Practice Address - Fax:207-602-5929
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT7862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9765Medicare ID - Type Unspecified