Provider Demographics
NPI:1801187661
Name:BUCKLEY, PATRICK KIM
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KIM
Last Name:BUCKLEY
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 1:396 DANBURY RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:396 DANBURY RD
Practice Address - Street 2:UNIT 5
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2024
Practice Address - Country:US
Practice Address - Phone:203-978-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist