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General NPI Number Information
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NPI Number | 1053623157
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Entity Type | Organization
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Legal Business Name | BUTTERFLY BOUTIQUE, LLC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 1950 E 70TH ST SUITE G
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City | SHREVEPORT
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State | LA
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Zip | 71105-5345
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Country | US
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Telephone | 318-798-5991
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Fax | 318-798-5992
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Provider Business Mailing Address
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Address Line | 1950 E 70TH ST STE G
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City | SHREVEPORT
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State | LA
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Zip | 71105-5345
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Country | US
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Telephone | 318-798-5991
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Fax | 318-798-5992
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | CHERIE BYERS
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Credential |
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Telephone | 318-798-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C49850
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License Number State | LA
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