Healthcare Provider Details

I. General information

NPI: 1649120502
Provider Name (Legal Business Name): BUTLER ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 BRIDGEPORT WAY W STE 304
UNIVERSITY PLACE WA
98466-4455
US

IV. Provider business mailing address

3929 BRIDGEPORT WAY W STE 304
UNIVERSITY PLACE WA
98466-4455
US

V. Phone/Fax

Practice location:
  • Phone: 253-317-4300
  • Fax:
Mailing address:
  • Phone: 253-317-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFERY DURAND BUTLER
Title or Position: OWNER / PEDORTHIST
Credential: CPED
Phone: 253-279-8778