Healthcare Provider Details

I. General information

NPI: 1255579348
Provider Name (Legal Business Name): CHRISTOPHER JAY BUTLER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S RAYMOND AVE
PASADENA CA
91105-3223
US

IV. Provider business mailing address

801 S RAYMOND AVE
PASADENA CA
91105-3223
US

V. Phone/Fax

Practice location:
  • Phone: 626-356-0599
  • Fax: 626-356-0570
Mailing address:
  • Phone: 626-356-0599
  • Fax: 626-356-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT34209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: