Provider Demographics
NPI:1225114093
Name:BUCKS, KATHY O (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:O
Last Name:BUCKS
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 1:800 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1707
Mailing Address - Country:US
Mailing Address - Phone:304-872-2735
Mailing Address - Fax:304-872-9416
Practice Address - Street 1:800 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1707
Practice Address - Country:US
Practice Address - Phone:304-872-2735
Practice Address - Fax:304-872-9416
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0201246000Medicaid
WVCE9281851Medicare ID - Type Unspecified