Provider Demographics
NPI:1477752152
Name:BUTLER, DAVID DARRELL (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DARRELL
Last Name:BUTLER
Suffix:
Gender:M
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:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-0362
Mailing Address - Country:US
Mailing Address - Phone:801-980-0860
Mailing Address - Fax:801-980-0862
Practice Address - Street 1:230 N 1200 E
Practice Address - Street 2:SUITE 103
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5865
Practice Address - Country:US
Practice Address - Phone:801-980-0860
Practice Address - Fax:801-980-0862
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66303612401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477752152Medicaid