Provider Demographics
NPI:1386983492
Name:BUTLER, TERRI (LMP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826
Mailing Address - Country:US
Mailing Address - Phone:808-264-4276
Mailing Address - Fax:
Practice Address - Street 1:10090 MAIN ST. SUITE G
Practice Address - Street 2:SNOWCREEK HEALTH CENTER
Practice Address - City:PESHASTIN
Practice Address - State:WA
Practice Address - Zip Code:98847
Practice Address - Country:US
Practice Address - Phone:509-548-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-8464225700000X
CA#36488225700000X
WAMA00008537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist