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General NPI Number Information
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NPI Number | 1902001639
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Entity Type | Individual
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Provider Name | KEVIN DONNEL BUTLER PTA
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1302 WEST PAYNE STREET
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City | OLNEY
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State | TX
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Zip | 76374
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Country | US
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Telephone | 940-564-4689
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Fax | 940-564-4689
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Provider Business Mailing Address
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Address Line | 4824 ALAMO DR
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City | WICHITA FALLS
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State | TX
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Zip | 76302-4146
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Country | US
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Telephone | 940-224-1599
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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 | 2049450
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License Number State | TX
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