Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 006155-1 | NY |
NPI | 1003913179 |
---|---|
Provider Name | Mrs. Jennifer Marie Butcher |
First Address | Tonawanda, NY 14150-9410 |
Second Address | Tonawanda, NY 14150-9410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |