Healthcare Provider Details

I. General information

NPI: 1861761611
Provider Name (Legal Business Name): KRISTEN MARIE BUTTERFIELD RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KRISTEN MARIE MANSON

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST PRATT
BROOKFIELD MO
64628
US

IV. Provider business mailing address

116 EAST PRATT
BROOKFIELD MO
64628
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-7402
  • Fax: 660-258-2364
Mailing address:
  • Phone: 660-258-7402
  • Fax: 660-258-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2008021942
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: