MEDICARE: JENNIFER E. BUTLER PT

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	PT-2037	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1651155	OTHER	ID	MEDICARE ID

General Provider Information

NPI Number	:	1982639878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E. BUTLER PT

Provider Business Mailing Address
First Line	:	9797 N GLEN HOLLOW LN
Second Line	:
City	:	HAUSER
State	:	ID
Zip	:	83854-6159
Country	:	US
Telephone Number	:	208-771-3579
Fax Number	:	208-561-6194

Provider Business Practice Location Address
First Line	:	9797 N GLEN HOLLOW LN
Second Line	:
City	:	HAUSER
State	:	ID
Zip	:	83854-6159
Country	:	US
Telephone Number	:	208-771-3579
Fax Number	:	208-561-6194

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/26/2024

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Directions to “ JENNIFER E. BUTLER PT” Practice Location

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