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General NPI Number Information
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NPI Number | 1023256112
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Entity Type | Individual
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Provider Name | JENNY MEGAN BUTLER PT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 5510 E. STATE ST.
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City | ROCKFORD
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State | IL
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Zip | 61108-2381
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Country | US
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Telephone | 815-395-4540
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Fax |
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Provider Business Mailing Address
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Address Line | 11073 BRANDING IRON LN
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City | ROSCOE
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State | IL
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Zip | 61073-8189
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Country | US
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Telephone | 815-222-4481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070013640
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License Number State | IL
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