| Doctor Name: | MR. DAVID C BOUTELLE |
| NPI Number: | 1063461101 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 12422 |
| Business Practice Address: | 9830 Prospect Ave Ste A Santee, CA - 920714375 |
| Business Phone Number: | 6194484860 |
| Business Fax Number: | 6194481639 |
| Mailing Address: | 540 S Andreasen Dr, Ste C ESCONDIDO |
| State: | CA |
| Postal Code: | 920291916 |
| Phone Number: | 7605917750 |
| Fax Number: | 7602949813 |
| NPI Enumeration Date: | 05/08/2006 |
| NPI Last Update Date: | 01/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 12422 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |