Provider Demographics
NPI:1023237922
Name:BUTCHER, MAREN ELIZA (PT)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:ELIZA
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 E CAROB PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2527
Mailing Address - Country:US
Mailing Address - Phone:480-659-1772
Mailing Address - Fax:
Practice Address - Street 1:793 N ALMA SCHOOL RD
Practice Address - Street 2:STE D4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3681
Practice Address - Country:US
Practice Address - Phone:480-626-4142
Practice Address - Fax:480-626-7370
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203062Medicaid