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Individual

JACK EDWARD BUTLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
5643 N ACADEMY BLVD, COLORADO SPGS, CO 80918-3658
(720) 316-9974
Mailing address
20150 SHERIFFS CV, MONUMENT, CO 80132-8046
(206) 619-0844

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0015515
CO

Other

Enumeration date
08/14/2024
Last updated
08/14/2024
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