Provider Demographics
NPI:1922537216
Name:BUCKLEY, LIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:LIAM
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MCADOO AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 MCADOO AVENUE
Practice Address - Street 2:APT 3F
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406
Practice Address - Country:US
Practice Address - Phone:336-898-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT29812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer