Provider Demographics
NPI:1053081331
Name:BUTLER, ANNA M (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-0489
Mailing Address - Country:US
Mailing Address - Phone:740-886-7878
Mailing Address - Fax:740-886-1609
Practice Address - Street 1:200 STATE ST
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-5090
Practice Address - Country:US
Practice Address - Phone:740-886-7878
Practice Address - Fax:740-886-1609
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.006879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist