Healthcare Provider Details

I. General information

NPI: 1962324806
Provider Name (Legal Business Name): BUTEAU MORESTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 SW IDAHO LN
PORT ST LUCIE FL
34953-1532
US

IV. Provider business mailing address

1897 SW IDAHO LN
PORT ST LUCIE FL
34953-1532
US

V. Phone/Fax

Practice location:
  • Phone: 772-621-0951
  • Fax:
Mailing address:
  • Phone: 772-621-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberM403-426-61-000-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: