Provider Demographics
NPI:1528740032
Name:BUTRY, BRANDON MICHAEL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:BUTRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4507
Mailing Address - Country:US
Mailing Address - Phone:941-493-6449
Mailing Address - Fax:941-496-4227
Practice Address - Street 1:1232 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4507
Practice Address - Country:US
Practice Address - Phone:941-493-6449
Practice Address - Fax:941-496-4227
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist