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THOMAS JACOB BUTKOVICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
7120 CORBIN AVE, RESEDA, CA 91335-3618
(818) 881-4540
Mailing address
118 MEDICAL DRIVE, LIFESPAN THERAPY, CARMEL, IN 46032
(812) 988-6666

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06005233A
IN
225200000X
Physical Therapy Assistant
Primary
2015036822
MO
225200000X
Physical Therapy Assistant
48919
CA

Other

Enumeration date
08/31/2016
Last updated
05/20/2025
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