Healthcare Provider Details

I. General information

NPI: 1235428228
Provider Name (Legal Business Name): JENNY BUTLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 3RD AVE W STE 110
BRADENTON FL
34205-8641
US

IV. Provider business mailing address

100 3RD AVE W STE 110
BRADENTON FL
34205-8641
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-9555
  • Fax: 941-708-5465
Mailing address:
  • Phone: 941-708-9555
  • Fax: 941-708-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberPT25098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: