Provider Demographics
NPI:1154780518
Name:BUTLER, EVA
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EVA
Other - Middle Name:NICOLE
Other - Last Name:LOPEZ-HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:4 VICTORIA SQ
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1108
Mailing Address - Country:US
Mailing Address - Phone:862-432-0897
Mailing Address - Fax:
Practice Address - Street 1:1600 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3626
Practice Address - Country:US
Practice Address - Phone:888-859-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0000783283X00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No283X00000XHospitalsRehabilitation Hospital