Healthcare Provider Details

I. General information

NPI: 1285739185
Provider Name (Legal Business Name): MATTHEW N BUTLER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 FAU BLVD STE 105
BOCA RATON FL
33431-6437
US

IV. Provider business mailing address

3848 FAU BLVD STE 105
BOCA RATON FL
33431-6437
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-2920
  • Fax:
Mailing address:
  • Phone: 561-395-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT29380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: