Provider Demographics
NPI:1134185259
Name:BUTLER, ERICKA (PTA)
Entity type:Individual
Prefix:MISS
First Name:ERICKA
Middle Name:
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 1:1741 W WOODROW ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2511
Mailing Address - Country:US
Mailing Address - Phone:918-698-7324
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:TULSA REGIONAL MEDICAL CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-599-5190
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA1165225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant