Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1699707737 |
---|---|
Provider Name | Mr. Brian Edward Buckoski |
First Address | Pineville, LA 71360-2784 |
Second Address | Pineville, LA 71360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |