Provider Demographics
NPI:1144568403
Name:BUCK, MELODY E (PT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:E
Last Name:BUCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MABRY HOOD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2669
Mailing Address - Country:US
Mailing Address - Phone:865-474-8410
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:614 MABRY HOOD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2669
Practice Address - Country:US
Practice Address - Phone:865-474-8410
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist