Healthcare Provider Details

I. General information

NPI: 1679773949
Provider Name (Legal Business Name): THERESA MARIE BUK L.P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S. RIVERSIDE PLAZA SUITE 830
CHICAGO IL
60606
US

IV. Provider business mailing address

320 BLACKHAWK RD
RIVERSIDE IL
60546-2304
US

V. Phone/Fax

Practice location:
  • Phone: 866-386-0773
  • Fax:
Mailing address:
  • Phone: 708-447-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: