Provider Demographics
NPI:1982274924
Name:BUTLER, CASSIE DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:DENISE
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 1:130 HUGHES RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9226
Mailing Address - Country:US
Mailing Address - Phone:731-614-2094
Mailing Address - Fax:
Practice Address - Street 1:14510 US-79
Practice Address - Street 2:
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-5317
Practice Address - Fax:731-352-5397
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5545225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant