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Individual
BONNIE ROSS BUTLER
Active
Individual
BONNIE ROSS BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,OCS,CSCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
377196-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52947112802001
BLUE CROSS BLUE SHIELD
UT
01
—
5417
DMBA
UT
01
—
6400593
UNITED HEALTHCARE
UT
01
—
69157
PEHP
UT
01
—
CJ9402
RAILROAD MEDICARE
UT
01
—
QM0000061055
ALTIUS
UT
Enumeration date
08/03/2005
Last updated
12/01/2009
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