Provider Demographics
NPI:1891906137
Name:BUTERA, JOHN (RMT PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BUTERA
Suffix:
Gender:M
Credentials:RMT PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8833
Mailing Address - Country:US
Mailing Address - Phone:719-339-3998
Mailing Address - Fax:719-687-7964
Practice Address - Street 1:7092 HARR AVE BLDG 6492
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80902-2190
Practice Address - Country:US
Practice Address - Phone:719-339-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAPTA-4698225200000X
COCO-4698225700000X
COCO-0013082225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist