Provider Demographics
NPI:1831606607
Name:BUCKLES, ERIKA (ATC)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:CREMEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:14829 SW MILLIKAN WAY APT 1015
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-5495
Mailing Address - Country:US
Mailing Address - Phone:925-876-7420
Mailing Address - Fax:
Practice Address - Street 1:930 SW HALL ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-9720
Practice Address - Country:US
Practice Address - Phone:503-725-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10171402204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAT-AT-10171402OtherOREGON HEALTH LICENSING