Provider Demographics
NPI:1275817413
Name:BUTLER, KRISTEN M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:J
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:150 SPRINGSIDE DRIVE
Mailing Address - Street 2:SUITE B250
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4572
Mailing Address - Country:US
Mailing Address - Phone:330-664-1600
Mailing Address - Fax:330-664-1606
Practice Address - Street 1:150 SPRINGSIDE DRIVE
Practice Address - Street 2:SUITE B250
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4572
Practice Address - Country:US
Practice Address - Phone:330-664-1600
Practice Address - Fax:330-664-1606
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007424225100000X
OHPT007424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430131Medicaid
OH2430131Medicaid