Provider Demographics
NPI:1326336462
Name:BUTLER, LAKECHA (PT)
Entity Type:Individual
Prefix:
First Name:LAKECHA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 FARRAH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1265
Mailing Address - Country:US
Mailing Address - Phone:817-847-4291
Mailing Address - Fax:
Practice Address - Street 1:5650 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2464
Practice Address - Country:US
Practice Address - Phone:817-569-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283815301Medicaid
TX868T66OtherBCBS