Jack Edward Butler

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA.0015515 Issued in CO

Practice address

5643 N Academy Blvd
Colorado SPGS, CO 80918-3658

Phone

(720) 316-9974

NPI assigned

Aug 14, 2024

Last updated

Aug 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Physioroom, LLC

  dba The Physioroom

  • Physical Therapist
  • Colorado Springs, CO
  • NPI 1366215147
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1114759743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20150 SHERIFFS CV",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801328046",
            "telephone_number": "206-619-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5643 N ACADEMY BLVD",
            "city": "COLORADO SPGS",
            "state": "CO",
            "postal_code": "809183658",
            "telephone_number": "720-316-9974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "JACK",
        "middle_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-14",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CO",
            "license": "PTA.0015515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabrina Biggerstaff
• Ashlea Corinne Bird
• C David Bird, M.D.
• Schey Boyd
• Hayden Brice
• Kristina Clay
• CNC Homecare Services LLC
• Theresa Cogan
• Colorado Rehabilitation Phys
• Rebecca Delametter, OTD, OTR/L

• Physical Therapy Assistant in Colorado SPGS, CO
• Providers in Colorado SPGS, CO by specialty
• Physical Therapy Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.