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General NPI Number Information
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NPI Number | 1255876199
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Entity Type | Individual
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Provider Name | MICHELLE BUTLER
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Gender | Female
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 11178 HURON ST
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City | NORTHGLENN
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State | CO
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Zip | 80234-4370
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Country | US
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Telephone | 303-434-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 7430 W 8TH PL
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City | LAKEWOOD
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State | CO
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Zip | 80214-4585
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Country | US
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Telephone | 720-372-6378
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0018024
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License Number State | CO
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