Provider Demographics
NPI:1598576605
Name:BUTLER, KRISTI LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEIGH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 MOUNTAIN VIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2387
Mailing Address - Country:US
Mailing Address - Phone:478-342-0289
Mailing Address - Fax:
Practice Address - Street 1:3890 MOUNTAIN VIEW RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2387
Practice Address - Country:US
Practice Address - Phone:478-342-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist