Provider Demographics
NPI:1417358508
Name:BUI, JIM (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WESTSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3868
Mailing Address - Country:US
Mailing Address - Phone:918-619-3256
Mailing Address - Fax:
Practice Address - Street 1:220 WESTSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3868
Practice Address - Country:US
Practice Address - Phone:918-619-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK829225100000X
TX62402081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist