Provider Demographics
NPI:1487896205
Name:BUTLER, NICHOLAS LEE (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CYPRESS ST
Mailing Address - Street 2:UNITS C & D
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7674
Mailing Address - Country:US
Mailing Address - Phone:318-397-3331
Mailing Address - Fax:318-397-3336
Practice Address - Street 1:4920 CYPRESS ST
Practice Address - Street 2:UNITS C & D
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7674
Practice Address - Country:US
Practice Address - Phone:318-397-3331
Practice Address - Fax:318-397-3336
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07424174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist