Basic Information
| Provider Information | |||||||||
| NPI: | 1588030761 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUTLER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1129 HIGHWAY 35 S | ||||||||
| Address2: | STE 2 | ||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390748829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158618751 | ||||||||
| FaxNumber: | 6158072295 | ||||||||
| Practice Location | |||||||||
| Address1: | 1129 HIGHWAY 35 S STE 2 | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390748829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014691001 | ||||||||
| FaxNumber: | 6014691009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5813 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.