Provider Demographics
NPI:1548563489
Name:BUTTS, LAURIE (MS, PT, CDE)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MS, PT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 FAIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1945
Mailing Address - Country:US
Mailing Address - Phone:815-871-7889
Mailing Address - Fax:
Practice Address - Street 1:79 FAIRFILED LANE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-1945
Practice Address - Country:US
Practice Address - Phone:815-871-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.006142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist