Provider Demographics
NPI:1720673494
Name:BUCK, ERIKA L (DPT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:BUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:L
Other - Last Name:NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1229 WENTZVILLE PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3553
Mailing Address - Country:US
Mailing Address - Phone:636-730-1118
Mailing Address - Fax:
Practice Address - Street 1:1229 WENTZVILLE PKWY STE 209
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3553
Practice Address - Country:US
Practice Address - Phone:636-730-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021006232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist