Basic Information
| Provider Information | |||||||||
| NPI: | 1982274924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 HUGHES RD E | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383059226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316142094 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14510 US-79 | ||||||||
| Address2: | |||||||||
| City: | MCKENZIE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313525317 | ||||||||
| FaxNumber: | 7313525397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2021 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5545 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.