Healthcare Provider Details

I. General information

NPI: 1538466156
Provider Name (Legal Business Name): ALEENA RENE BUTLER D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 STATE ROAD 13 N STE 21
FRUIT COVE FL
32259-2824
US

IV. Provider business mailing address

PO BOX 290699
PORT ORANGE FL
32129-0699
US

V. Phone/Fax

Practice location:
  • Phone: 708-476-0332
  • Fax:
Mailing address:
  • Phone: 386-432-2986
  • Fax: 386-492-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: