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General NPI Number Information
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NPI Number | 1871078386
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Entity Type | Individual
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Provider Name | SEAN PATRICK BOUTHILETTE DPT
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 08/10/2025
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Provider Practice Location Address
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Address Line | 5716 W GATE CITY BLVD
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City | GREENSBORO
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State | NC
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Zip | 27407-7039
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Country | US
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Telephone | 336-600-9930
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Fax | 336-600-9960
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Provider Business Mailing Address
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Address Line | 204 MATTHEWS DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-4302
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Country | US
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Telephone | 919-578-4200
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Fax | 919-578-9922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2305212305
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P21138
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License Number State | NC
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