Provider Demographics
NPI:1851550446
Name:BUCKLEY, ERIN (MSPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ORIENT ST
Mailing Address - Street 2:APT 3
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3711
Mailing Address - Country:US
Mailing Address - Phone:978-549-6265
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN STREET
Practice Address - Street 2:EASTER SEALS MASSACHUSETTS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:508-831-9768
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist