MEDICARE: BRANDON MICHAEL BUTRY

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	PT40562	FL

General Provider Information

NPI Number	:	1528740032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON MICHAEL BUTRY

Provider Business Mailing Address
First Line	:	1232 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4507
Country	:	US
Telephone Number	:	941-493-6449
Fax Number	:	941-496-4227

Provider Business Practice Location Address
First Line	:	1232 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4507
Country	:	US
Telephone Number	:	941-493-6449
Fax Number	:	941-496-4227

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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Directions to “ BRANDON MICHAEL BUTRY ” Practice Location

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