Provider Demographics
NPI:1801286513
Name:BUTLER, SHAKIRA M (CMT)
Entity type:Individual
Prefix:MRS
First Name:SHAKIRA
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 STAFFORD WAY STE C
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3333
Mailing Address - Country:US
Mailing Address - Phone:530-671-4616
Mailing Address - Fax:530-671-6062
Practice Address - Street 1:1095 STAFFORD WAY STE C
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3333
Practice Address - Country:US
Practice Address - Phone:530-671-4616
Practice Address - Fax:530-671-6062
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62894OtherSTATE LICENSE