Basic Information
| Provider Information | |||||||||
| NPI: | 1730669680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | TONYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 CHEYENNE RUN | ||||||||
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| City: | HALLSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756505015 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2131 ALPINE RD | ||||||||
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| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756013402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037578786 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2102460 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.