Provider Demographics
NPI:1982639878
Name:BUTLER, JENNIFER E (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21651 E COUNTY VISTA DR
Mailing Address - Street 2:STE E
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7710
Mailing Address - Country:US
Mailing Address - Phone:509-822-7834
Mailing Address - Fax:509-863-9673
Practice Address - Street 1:12615 E MISSION AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3060
Practice Address - Country:US
Practice Address - Phone:509-891-2623
Practice Address - Fax:509-891-2624
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1651155OtherMEDICARE ID