Provider Demographics
NPI:1083950364
Name:SCHRADER BUTELLO, JULIE (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SCHRADER BUTELLO
Suffix:
Gender:F
Credentials:PTA
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 6
Mailing Address - Street 2:123 E JOHNSON AVENUE
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0006
Mailing Address - Country:US
Mailing Address - Phone:509-682-4713
Mailing Address - Fax:509-682-3218
Practice Address - Street 1:123 E JOHNSON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-0006
Practice Address - Country:US
Practice Address - Phone:509-682-4713
Practice Address - Fax:509-682-3218
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60176660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant