1609689959 NPI number — BROOKE CHRISTEN RUTH BUTLER PT, DPT

Table of content: BROOKE CHRISTEN RUTH BUTLER PT, DPT (NPI 1609689959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609689959 NPI number — BROOKE CHRISTEN RUTH BUTLER PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
BROOKE
Provider Middle Name:
CHRISTEN RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609689959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234-B W HOUSTON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-259-1888
Provider Business Mailing Address Fax Number:
918-251-3725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EXCEL THERAPY SPECIALISTS, LLC
Provider Second Line Business Practice Location Address:
536 N MAIN STREET
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401-6345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-683-8555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6640 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)