MEDICARE: MARK GORDON BUCKLEY L.M.T., M.M.P.

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	225700000X	Massage Therapist	NV20151219246	NV

General Provider Information

NPI Number	:	1245691344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GORDON BUCKLEY L.M.T., M.M.P.

Provider Business Mailing Address
First Line	:	2740 SILVER AVE
Second Line	:
City	:	SANDY VALLEY
State	:	NV
Zip	:	89019-8539
Country	:	US
Telephone Number	:	702-466-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 SILVER AVE
Second Line	:
City	:	SANDY VALLEY
State	:	NV
Zip	:	89019-8539
Country	:	US
Telephone Number	:	702-466-2626
Fax Number	:

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

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	03/16/2016

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