Provider Demographics
NPI:1154645422
Name:BUELT, DOUGLAS C (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:C
Last Name:BUELT
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 1:620 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-1444
Mailing Address - Country:US
Mailing Address - Phone:217-357-9000
Mailing Address - Fax:217-357-9013
Practice Address - Street 1:620 WABASH AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1444
Practice Address - Country:US
Practice Address - Phone:217-357-9000
Practice Address - Fax:217-357-9013
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist