Provider Demographics
NPI:1164407250
Name:BUTLER, LARRY (CP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 US HIGHWAY 64
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4066
Mailing Address - Country:US
Mailing Address - Phone:901-507-7821
Mailing Address - Fax:901-507-7824
Practice Address - Street 1:7625 US HIGHWAY 64
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4066
Practice Address - Country:US
Practice Address - Phone:901-507-7821
Practice Address - Fax:901-507-7824
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003654222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5402060001Medicare NSC