Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT000847 | GA |
NPI | 1003118381 |
---|---|
Provider Name | Katherine Butler |
First Address | Watkinsville, GA 30677-3393 |
Second Address | Watkinsville, GA 30677-3393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2010 |
Last Update Date | 19/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT000847 | GA STATE LICENSE (01) | GA |