Provider Demographics
NPI:1205082880
Name:BUTLER, PHYLLIS JANE (PTA ASSOCIATE)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:JANE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PTA ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1536
Mailing Address - Country:US
Mailing Address - Phone:817-594-8713
Mailing Address - Fax:
Practice Address - Street 1:521 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-1536
Practice Address - Country:US
Practice Address - Phone:817-594-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
TX2022408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant