Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 011688 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 011688 | NY |
NPI | 1497965032 |
---|---|
Provider Name | Michael Eugene Buck |
First Address | Horseheads, NY 14845-9335 |
Second Address | Horseheads, NY 14845-9335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |