Healthcare Provider Details

I. General information

NPI: 1396449088
Provider Name (Legal Business Name): BUTLER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9797 N GLEN HOLLOW LN
HAUSER ID
83854-6159
US

IV. Provider business mailing address

9797 N GLEN HOLLOW LN
HAUSER ID
83854-6159
US

V. Phone/Fax

Practice location:
  • Phone: 208-771-3579
  • Fax:
Mailing address:
  • Phone: 208-771-3579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BUTLER
Title or Position: OWNER
Credential: MPT
Phone: 208-771-3579