Provider Demographics
NPI:1790828275
Name:BUTLER, ANGELIA DEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:DEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15102 COUNTY ROAD 602
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:77534-9741
Mailing Address - Country:US
Mailing Address - Phone:979-922-1153
Mailing Address - Fax:
Practice Address - Street 1:3040 POST OAK BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6500
Practice Address - Country:US
Practice Address - Phone:713-965-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant