Individual
MR. TRENT LYDELL BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1883 HIGHWAY 43 S, SUITE C, CANTON, MS 39046-8405
(601) 859-2906
(601) 859-0483
Mailing address
1883 HIGHWAY 43 S, SUITE C, CANTON, MS 39046-8405
(601) 859-2906
(601) 859-0483
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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