Basic Information
| Provider Information | |||||||||
| NPI: | 1255662151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTTS | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT DPT MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 WILLIAMSBURG PLZ | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402225097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024124486 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3010 FARROW RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292037607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034341210 | ||||||||
| FaxNumber: | 8034344331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2010 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6104 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.