Provider Demographics
NPI:1205991742
Name:BUTKA, DAVID (MPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BUTKA
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 1:36273 MARGARETA ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2869
Mailing Address - Country:US
Mailing Address - Phone:248-478-3668
Mailing Address - Fax:734-432-6607
Practice Address - Street 1:36273 MARGARETA ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2869
Practice Address - Country:US
Practice Address - Phone:248-478-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist