Provider Demographics
NPI:1659630994
Name:BUTTS, CHARLES J (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:BUTTS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 COUNTY HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-6055
Mailing Address - Country:US
Mailing Address - Phone:205-353-6976
Mailing Address - Fax:
Practice Address - Street 1:3555 COUNTY HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-6055
Practice Address - Country:US
Practice Address - Phone:205-353-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA5926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant