Provider Demographics
NPI:1497056923
Name:HUFFMAN, CAROL BUCKLEY (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:BUCKLEY
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MAXINE
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7876 AMERICAN RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8337
Mailing Address - Country:US
Mailing Address - Phone:815-847-9717
Mailing Address - Fax:
Practice Address - Street 1:7876 AMERICAN RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-8337
Practice Address - Country:US
Practice Address - Phone:815-847-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-004891225100000X
NY008675-1225100000X
PAPT-005183L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist