Provider Demographics
NPI:1477142180
Name:BUTLER, MYRA E (LMT)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:E
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 MCGRAW AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1960
Mailing Address - Country:US
Mailing Address - Phone:917-714-2030
Mailing Address - Fax:
Practice Address - Street 1:1824 MCGRAW AVE APT 3B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1960
Practice Address - Country:US
Practice Address - Phone:917-714-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032291225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist