Basic Information
| Provider Information | |||||||||
| NPI: | 1124347232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCKLEY | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7220 LISBON RD | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444329323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395711440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2904 N RIDGE RD E | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440044302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409927500 | ||||||||
| FaxNumber: | 4409928366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 05/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 012520 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.