Provider Demographics
NPI:1609092758
Name:BUTLER, DARLENE LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:LYNN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 STATE ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003
Mailing Address - Country:US
Mailing Address - Phone:440-293-7278
Mailing Address - Fax:440-293-8432
Practice Address - Street 1:5531 STATE ROUTE 6
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003
Practice Address - Country:US
Practice Address - Phone:440-293-7278
Practice Address - Fax:440-293-8432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.05389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant