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General NPI Number Information
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NPI Number | 1548440159
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Entity Type | Organization
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Legal Business Name | DAVE BUTKA INC
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 36273 MARGARETA ST
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City | LIVONIA
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State | MI
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Zip | 48152-2869
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Country | US
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Telephone | 248-478-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 36273 MARGARETA ST
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City | LIVONIA
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State | MI
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Zip | 48152-2869
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Country | US
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Telephone | 248-478-3668
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID RICHARD BUTKA
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Credential | PT
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Telephone | 248-478-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005110
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License Number State | MI
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