Healthcare Provider Details

I. General information

NPI: 1598098923
Provider Name (Legal Business Name): PATRICIA BUTLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 N CALIFORNIA AVE STE 301
CHICAGO IL
60618-7702
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-5639
  • Fax: 773-777-5927
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160-005267
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: