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Individual
MR. TRENT LYDELL BUTLER
Active
Individual
MR. TRENT LYDELL BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1156
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126758
—
MS
01
—
302II655874
PROVIDER TRANSACTION ACCESS NUMBER
MS
01
—
512I650002
OLD MEDICARE PTAN
MS
01
—
P00147565
RRMEDICARE
MS
01
—
P00618853
UP MEDICARE RAILROAD
MS
Enumeration date
07/05/2006
Last updated
06/28/2012
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