Healthcare Provider Details

I. General information

NPI: 1881106821
Provider Name (Legal Business Name): SYDNEY BUTLER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W 27TH ST
CEDAR FALLS IA
50614-0012
US

IV. Provider business mailing address

3210 SPRING VALLEY LN APT D3
CEDAR FALLS IA
50613-4845
US

V. Phone/Fax

Practice location:
  • Phone: 319-273-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2255A2300X
Identifier TypeOTHER
Identifier State
Identifier IssuerTRUMAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: