MEDICARE: KELSEY BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1306591748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY BUTLER

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5227 ROBINHOOD VILLAGE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-9819
Country	:	US
Telephone Number	:	336-923-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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Directions to “ KELSEY BUTLER ” Practice Location

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