Provider Demographics
NPI:1083870505
Name:BUCKLER, MICHAEL CLAY (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLAY
Last Name:BUCKLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 RESEARCH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1087
Mailing Address - Country:US
Mailing Address - Phone:719-623-1050
Mailing Address - Fax:719-623-1052
Practice Address - Street 1:2430 RESEARCH PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1093
Practice Address - Country:US
Practice Address - Phone:719-623-1050
Practice Address - Fax:719-623-1053
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist