Healthcare Provider Details

I. General information

NPI: 1306157383
Provider Name (Legal Business Name): BRANDI L BUCKLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BROWN AVE
ALMA NE
68920
US

IV. Provider business mailing address

2810 W 35TH ST STE 2
KEARNEY NE
68845-2909
US

V. Phone/Fax

Practice location:
  • Phone: 308-928-3002
  • Fax: 308-928-2774
Mailing address:
  • Phone: 308-237-7388
  • Fax: 308-237-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-02734
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3049
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: