Provider Demographics
NPI:1659696847
Name:BUTERWORTH, LESLIE (LAC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BUTERWORTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ODELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1647
Mailing Address - Country:US
Mailing Address - Phone:210-862-8470
Mailing Address - Fax:210-878-4297
Practice Address - Street 1:5282 MEDICAL DR STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6072
Practice Address - Country:US
Practice Address - Phone:210-862-8470
Practice Address - Fax:210-878-4297
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist