Provider Demographics
NPI:1821302019
Name:BUTLER, JESSICA ARNIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ARNIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ARNIE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:28 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6105
Mailing Address - Country:US
Mailing Address - Phone:207-873-4302
Mailing Address - Fax:207-873-4508
Practice Address - Street 1:28 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6105
Practice Address - Country:US
Practice Address - Phone:207-873-4302
Practice Address - Fax:207-873-4508
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist