Provider Demographics
NPI:1174625123
Name:BUCKLEY, MEGAN L (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4434
Practice Address - Country:US
Practice Address - Phone:757-232-8769
Practice Address - Fax:757-232-8875
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA23052024162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic