Provider Demographics
NPI:1487926259
Name:BUTTS, CAITLIN E (DPT)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:E
Last Name:BUTTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:E
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 441146
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9522
Mailing Address - Country:US
Mailing Address - Phone:770-917-1395
Mailing Address - Fax:
Practice Address - Street 1:2065 E SOUTH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2458
Practice Address - Country:US
Practice Address - Phone:334-288-8358
Practice Address - Fax:334-288-9681
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-33644OtherBCBS OF AL
AL12504756OtherCAQH
AL511-43506OtherBCBS OF AL
ALP01583941OtherRR MEDICARE
AL511-23756OtherBCBS OF AL
AL511-23759OtherBCBS OF AL
AL511-23756OtherBCBS OF AL
AL102I658524Medicare PIN
AL102I653236Medicare PIN