MEDICARE: MR. JOHN BUTERA RMT PTA

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	225200000X	Physical Therapy Assistant	CAPTA-4698	CA
2	225700000X	Massage Therapist	CO-4698	CO
3	225200000X	Physical Therapy Assistant	CO-0013082	CO

General Provider Information

NPI Number	:	1891906137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN BUTERA RMT PTA

Provider Business Mailing Address
First Line	:	115 PENNSYLVANIA AVE
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-8833
Country	:	US
Telephone Number	:	719-339-3998
Fax Number	:	719-687-7964

Provider Business Practice Location Address
First Line	:	7092 HARR AVE BLDG 6492
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80902-2190
Country	:	US
Telephone Number	:	719-339-3998
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/07/2025

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