Healthcare Provider Details

I. General information

NPI: 1013562370
Provider Name (Legal Business Name): CONNOR ALEXANDER BUCK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 N CHURCH RD STE B
KANSAS CITY MO
64158-1103
US

IV. Provider business mailing address

1991 FORDHAM DR STE 100
FAYETTEVILLE NC
28304-3774
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4653
  • Fax:
Mailing address:
  • Phone: 910-484-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021015010
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP19074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: