Healthcare Provider Details

I. General information

NPI: 1447226964
Provider Name (Legal Business Name): NIKKI LYNN BUTLER P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 JOEL DR. BLANCHFIELD ARMY COMMUNITY HOSPITAL
FORT CAMPBELL KY
42223-5349
US

IV. Provider business mailing address

1361 W RHETT BUTLER RD
CLARKSVILLE TN
37042-4546
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8102
  • Fax:
Mailing address:
  • Phone: 931-572-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT1859
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: