Provider Demographics
NPI:1588030761
Name:BUTLER, CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
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 1:1129 HIGHWAY 35 S
Mailing Address - Street 2:STE 2
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-8829
Mailing Address - Country:US
Mailing Address - Phone:615-861-8751
Mailing Address - Fax:615-807-2295
Practice Address - Street 1:1129 HIGHWAY 35 S STE 2
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-8829
Practice Address - Country:US
Practice Address - Phone:601-469-1001
Practice Address - Fax:601-469-1009
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist