Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1003372210 |
---|---|
Provider Name | Peter Buscheck |
First Address | Felton, CA 95018-9750 |
Second Address | Santa Cruz, CA 95062-2096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |