MEDICARE: CAMMIE JANE BUTZBACH

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	PTA32544	FL

General Provider Information

NPI Number	:	1548139223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMMIE JANE BUTZBACH

Provider Business Mailing Address
First Line	:	4517 SW CACAO ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-6545
Country	:	US
Telephone Number	:	561-329-6915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9319
Country	:	US
Telephone Number	:	772-359-4750
Fax Number	:

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

Provider Enumeration Date	:	11/01/2025
Last Update Date	:	11/07/2025

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Directions to “ CAMMIE JANE BUTZBACH ” Practice Location

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