Provider Demographics
NPI:1689981862
Name:BUCKO, JOSHUA JAMES
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:BUCKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1643
Mailing Address - Country:US
Mailing Address - Phone:860-399-6216
Mailing Address - Fax:860-399-4053
Practice Address - Street 1:1775 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1643
Practice Address - Country:US
Practice Address - Phone:860-399-6216
Practice Address - Fax:860-399-4053
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000641225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant