MEDICARE: MRS. JANET STARK BUTTERMORE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1300X	Clinical Electrophysiology Physical Therapist	EK 24	CA
2	2251P0200X	Pediatric Physical Therapist	PT 9593	CA

General Provider Information

NPI Number	:	1083634588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET STARK BUTTERMORE PT

Provider Business Mailing Address
First Line	:	11506 MESA MADERA CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1918
Country	:	US
Telephone Number	:	858-693-3563
Fax Number	:

Provider Business Practice Location Address
First Line	:	11858 BERNARDO PLAZA CT
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2439
Country	:	US
Telephone Number	:	858-673-5437
Fax Number	:	858-673-5434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/11/2016

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