Provider Demographics
NPI:1619545589
Name:BUTLER, HEATHER (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:10171 CHUMSTICK HWY
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-8762
Mailing Address - Country:US
Mailing Address - Phone:509-548-3133
Mailing Address - Fax:
Practice Address - Street 1:10171 CHUMSTICK HWY
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-8762
Practice Address - Country:US
Practice Address - Phone:509-548-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160557621225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant