Provider Demographics
NPI:1932710654
Name:BUTRANON, PEECHIT (RPT, RN)
Entity Type:Individual
Prefix:
First Name:PEECHIT
Middle Name:
Last Name:BUTRANON
Suffix:
Gender:M
Credentials:RPT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 LA COSTA
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5684
Mailing Address - Country:US
Mailing Address - Phone:323-420-8233
Mailing Address - Fax:
Practice Address - Street 1:6173 LA COSTA
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5684
Practice Address - Country:US
Practice Address - Phone:323-420-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist