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1114759743
JACK EDWARD BUTLER
COLORADO SPGS, CO
NPI
1114759743
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CO PTA.0015515)
Enumeration Date
2024-08-14
Last Update Date
2024-08-14
Business Address
JACK EDWARD BUTLER
5643 N ACADEMY BLVD
COLORADO SPGS, CO 80918-3658
Phone number: 720-316-9974
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Mailing Address
JACK EDWARD BUTLER
20150 SHERIFFS CV
MONUMENT, CO 80132-8046
Phone number: 206-619-0844
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