MEDICARE: ALEENA RENE BUTLER D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT26192	FL

General Provider Information

NPI Number	:	1538466156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEENA RENE BUTLER D.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 290699
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-0699
Country	:	US
Telephone Number	:	386-432-2986
Fax Number	:	386-492-2987

Provider Business Practice Location Address
First Line	:	445 STATE ROAD 13 N STE 21
Second Line	:
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-2824
Country	:	US
Telephone Number	:	708-476-0332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	12/07/2023

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