Individual
MR. KENNETH T BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
325 CHERRY AVE, MC KENZIE, TN 38201-1769
(731) 415-2701
Mailing address
325 CHERRY AVE, MC KENZIE, TN 38201-1769
(731) 415-2701
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0000000564
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-0548913
TAX ID
TN
Enumeration date
10/06/2005
Last updated
10/18/2010
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