MEDICARE: BREANNA BUTCHER

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	225100000X	Physical Therapist	CP042114T	GA
2	225100000X	Physical Therapist	P23773	NC
3	225100000X	Physical Therapist	CP043886T	WV

General Provider Information

NPI Number	:	1144033911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA BUTCHER

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SUNBRIDGE DR
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-8400
Country	:	US
Telephone Number	:	304-782-3000
Fax Number	:

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

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	04/22/2025

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Directions to “ BREANNA BUTCHER ” Practice Location

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