Provider Demographics
NPI:1972345890
Name:BUTTERWORTH, BLAINE MICHAEL (DPT)
Entity type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:MICHAEL
Last Name:BUTTERWORTH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W 8TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2392
Mailing Address - Country:US
Mailing Address - Phone:614-398-0804
Mailing Address - Fax:
Practice Address - Street 1:4343 ALL SEASONS DR STE 110
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1961
Practice Address - Country:US
Practice Address - Phone:614-541-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist