Provider Demographics
NPI:1891238887
Name:BUTLER, JOLI (DPT)
Entity Type:Individual
Prefix:
First Name:JOLI
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-454-1945
Mailing Address - Fax:360-454-1991
Practice Address - Street 1:2901 174TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4743
Practice Address - Country:US
Practice Address - Phone:360-454-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60697250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0365718OtherL & I
WA0365704OtherL & I
WA0365719OtherL & I
WA0365706OtherL & I
WA0365699OtherL & I
WA0365704OtherL & I
WA0365699OtherL & I
WA0365719OtherL & I
WAG8960586Medicare PIN
WAG8960538Medicare PIN
WAG8960587Medicare PIN