Provider Demographics
NPI:1942459896
Name:BUCAYAN, EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BUCAYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 STONECREEK PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2198
Mailing Address - Country:US
Mailing Address - Phone:512-733-7701
Mailing Address - Fax:512-733-7704
Practice Address - Street 1:2805 STONECREEK PL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2198
Practice Address - Country:US
Practice Address - Phone:512-733-7701
Practice Address - Fax:512-733-7704
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX172395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist