Healthcare Provider Details

I. General information

NPI: 1659079275
Provider Name (Legal Business Name): BLAIR WILLIAM BUTLER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

987 QUEEN ST APT 3804
HONOLULU HI
96814-3338
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5632
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: