Provider Demographics
NPI:1760848428
Name:BUTLER, TYLER KEITH (DPT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:KEITH
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5050
Mailing Address - Country:US
Mailing Address - Phone:337-533-8410
Mailing Address - Fax:337-533-8411
Practice Address - Street 1:522 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5050
Practice Address - Country:US
Practice Address - Phone:337-533-8410
Practice Address - Fax:337-533-8411
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty