Healthcare Provider Details

I. General information

NPI: 1003046301
Provider Name (Legal Business Name): JAMIE BUTTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 ESCAMBIA DR
WINTER HAVEN FL
33884-1468
US

IV. Provider business mailing address

208 ESCAMBIA ROAD
WINTER HAVEN FL
33884-1468
US

V. Phone/Fax

Practice location:
  • Phone: 863-534-1862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 18913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: