Provider Demographics
NPI:1093770067
Name:BUTLER, ALAN EDWARD (ATC, LAT, PTA)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:EDWARD
Last Name:BUTLER
Suffix:
Gender:M
Credentials:ATC, LAT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 GIANNA WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7820
Mailing Address - Country:US
Mailing Address - Phone:813-920-1490
Mailing Address - Fax:
Practice Address - Street 1:10610 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3641
Practice Address - Country:US
Practice Address - Phone:813-983-0440
Practice Address - Fax:813-983-8110
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19714225200000X
FLAL15742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer