Healthcare Provider Details

I. General information

NPI: 1346985181
Provider Name (Legal Business Name): JUSTIN BUTLER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COPPERFIELD CIR
LITITZ PA
17543-9482
US

IV. Provider business mailing address

44 COPPERFIELD CIR
LITITZ PA
17543-9482
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-6288
  • Fax: 717-626-0203
Mailing address:
  • Phone: 717-626-6288
  • Fax: 717-626-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG013820
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1234567
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMASSAGE THERAPY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: