Provider Demographics
NPI:1013460179
Name:BUTLER, LAURA BETH (PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
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 1:1919 US 64 WEST
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8506
Mailing Address - Country:US
Mailing Address - Phone:870-208-6370
Mailing Address - Fax:
Practice Address - Street 1:661 HIGHWAY 64B
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-8506
Practice Address - Country:US
Practice Address - Phone:870-208-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4129225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant