Provider Demographics
NPI:1861790388
Name:GEROY, BUTCH TERENCE D (PT)
Entity type:Individual
Prefix:
First Name:BUTCH TERENCE
Middle Name:D
Last Name:GEROY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S1097 WESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-8273
Mailing Address - Country:US
Mailing Address - Phone:715-778-5576
Mailing Address - Fax:715-778-5574
Practice Address - Street 1:400 W 9TH ST N STE 4
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1264
Practice Address - Country:US
Practice Address - Phone:715-717-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11663-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist