Provider Demographics
NPI:1770682262
Name:BUTLER, DEAN (PT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-7244
Mailing Address - Country:US
Mailing Address - Phone:501-777-9359
Mailing Address - Fax:501-777-0188
Practice Address - Street 1:1405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-7244
Practice Address - Country:US
Practice Address - Phone:501-777-9359
Practice Address - Fax:501-777-0188
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR478405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56134OtherBLUE CROSS
AR110844721Medicaid
AR650001260OtherRAILROAD MEDICARE
AR110844721Medicaid