Provider Demographics
NPI:1578445771
Name:BUTLER, JUNIOR (WORLDBOXING CHAMPION)
Entity type:Individual
Prefix:
First Name:JUNIOR
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:WORLDBOXING CHAMPION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W BASELINE RD APT 1097
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5392
Mailing Address - Country:US
Mailing Address - Phone:480-430-1487
Mailing Address - Fax:
Practice Address - Street 1:1311 W BASELINE RD APT 1097
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5392
Practice Address - Country:US
Practice Address - Phone:480-430-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer