Provider Demographics
NPI:1457660193
Name:BUCKNER, STACEY (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BUCKNER
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 1:1101 WOOTTON PKWY
Mailing Address - Street 2:9TH FLOOR, SUITE 900
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1059
Mailing Address - Country:US
Mailing Address - Phone:301-493-9409
Mailing Address - Fax:
Practice Address - Street 1:1101 WOOTTON PKWY
Practice Address - Street 2:9TH FLOOR, SUITE 900
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1059
Practice Address - Country:US
Practice Address - Phone:301-493-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist