Provider Demographics
NPI:1285940791
Name:RICHARD M BUTTNER DPT PC
Entity type:Organization
Organization Name:RICHARD M BUTTNER DPT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-630-4435
Mailing Address - Street 1:24325 HOWARD CIR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-4839
Mailing Address - Country:US
Mailing Address - Phone:402-630-4435
Mailing Address - Fax:402-502-1807
Practice Address - Street 1:24325 HOWARD CIR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-4839
Practice Address - Country:US
Practice Address - Phone:402-630-4435
Practice Address - Fax:402-502-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1674320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities