MEDICARE: WILLIAM I BUCK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	007431	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053891200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM I BUCK DPT

Provider Business Mailing Address
First Line	:	330 WALLER AVE STE 275
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2930
Country	:	US
Telephone Number	:	859-447-8600
Fax Number	:	859-447-8599

Provider Business Practice Location Address
First Line	:	127 CLAY DR
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1349
Country	:	US
Telephone Number	:	859-756-3281
Fax Number	:	859-756-3640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	04/13/2023

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