Provider Demographics
NPI:1932498615
Name:BUTLER, VICKY (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3724 HIDDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3031
Mailing Address - Country:US
Mailing Address - Phone:405-206-2145
Mailing Address - Fax:405-840-3256
Practice Address - Street 1:6400 N SANTA FE AVE
Practice Address - Street 2:STE. B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist