Provider Demographics
NPI:1932406592
Name:BUTLER, GENEVIEVE MARIE EUDURIA (LMT)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARIE EUDURIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BOZEMAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6683
Mailing Address - Country:US
Mailing Address - Phone:406-600-7898
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHLAND BLVD
Practice Address - Street 2:SUITE 4420
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6901
Practice Address - Country:US
Practice Address - Phone:406-556-5140
Practice Address - Fax:406-556-5145
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10258225700000X
MT138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist