Provider Demographics
NPI:1316915283
Name:BUTHOD, COURTNEY L (MSPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:BUTHOD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 S YALE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:918-481-3390
Mailing Address - Fax:918-481-3510
Practice Address - Street 1:8011 S SHERIDAN RD
Practice Address - Street 2:STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-481-3390
Practice Address - Fax:918-481-3510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
376585Medicare ID - Type Unspecified