Healthcare Provider Details

I. General information

NPI: 1083634588
Provider Name (Legal Business Name): JANET STARK BUTTERMORE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11858 BERNARDO PLAZA CT SUITE 110
SAN DIEGO CA
92128-2439
US

IV. Provider business mailing address

11506 MESA MADERA CT
SAN DIEGO CA
92131-1918
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5437
  • Fax: 858-673-5434
Mailing address:
  • Phone: 858-693-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberEK 24
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 9593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: