MEDICARE: BERENDA BUTLER MPT

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
1	225100000X	Physical Therapist	PT20480	CA

General Provider Information

NPI Number	:	1447302765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERENDA BUTLER MPT

Provider Business Mailing Address
First Line	:	6520 GREEN VALLEY CIR APT 315
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-8019
Country	:	US
Telephone Number	:	310-645-3758
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HARVARD AVE # 260
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4716
Country	:	US
Telephone Number	:	909-981-7251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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