Provider Demographics
NPI:1477998623
Name:BUTLER, WILLIAM DEANE (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEANE
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 1:196 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2365
Mailing Address - Country:US
Mailing Address - Phone:315-787-4577
Mailing Address - Fax:315-787-4573
Practice Address - Street 1:789 PRE EMPTION RD
Practice Address - Street 2:SUITE 500
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2069
Practice Address - Country:US
Practice Address - Phone:315-230-5565
Practice Address - Fax:315-719-0022
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003558-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist