Most Relevant Information
Provider Data
| NPI Number: | 1003219973 |
| Provider Name: | KELLY BUCKMAN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 004861 |
Most Important Dates
| Enumeration Date: | 10/06/2014 |
| Last Updated: | 10/06/2014 |
Provider Practice Location
201 W BROADWAY
COUNCIL BLUFFS
IA
515039004
Practice Location Phone/Fax
| Phone: | 7123299419 |
| Fax: | 7123290329 |
Provider Mailing Location
201 W BROADWAY
COUNCIL BLUFFS
IA
515039004
Provider Mailing Phone/Fax
| Phone: | 7123299419 |
| Fax: | 7123290329 |