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NPI Code Detail

MEDICARE: BONNIE ROSS BUTLER PT,OCS,CSCS

MEDICARE: BONNIE ROSS BUTLER PT,OCS,CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist377196-2401UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4CJ9402OTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152947112802001OTHERUTBLUE CROSS BLUE SHIELD
26400593OTHERUTUNITED HEALTHCARE
35417OTHERUTDMBA
5QM0000061055OTHERUTALTIUS
669157OTHERUTPEHP

General Provider Information

NPI Number : 1255332938
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE ROSS BUTLER PT,OCS,CSCS
Provider Business Mailing Address
First Line : 5151 S 900 E
Second Line : #100
City : SALT LAKE CITY
State : UT
Zip : 84117-6657
Country : US
Telephone Number : 801-261-3321
Fax Number : 801-261-5942
Provider Business Practice Location Address
First Line : 5151 S 900 E
Second Line : #100
City : SALT LAKE CITY
State : UT
Zip : 84117-6601
Country : US
Telephone Number : 801-261-3321
Fax Number : 801-261-5942
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 12/01/2009

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