MEDICARE: MRS. MARY E BUTTACAVOLI MSPT

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	40QAO1175300	NJ

General Provider Information

NPI Number	:	1477617280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY E BUTTACAVOLI MSPT

Provider Business Mailing Address
First Line	:	1454 GOLDEN HEMLOCK WAY
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2869
Country	:	US
Telephone Number	:	732-575-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1372 ROUTE 9
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-4038
Country	:	US
Telephone Number	:	732-240-9256
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/28/2026

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