Provider Demographics
NPI:1962389908
Name:BUTLER, JOHN L JR (PTA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 EMMETT DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-6612
Mailing Address - Country:US
Mailing Address - Phone:704-604-1457
Mailing Address - Fax:
Practice Address - Street 1:1738 CELANESE RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1731
Practice Address - Country:US
Practice Address - Phone:803-670-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7069225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant