Provider Demographics
NPI:1053767905
Name:BUTLER, PAMELA WAMPLER (RPT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:WAMPLER
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PETERSON PL
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2055
Mailing Address - Country:US
Mailing Address - Phone:540-942-2532
Mailing Address - Fax:
Practice Address - Street 1:339 WESTMINISTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2111
Practice Address - Country:US
Practice Address - Phone:540-949-8665
Practice Address - Fax:540-943-8691
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist