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General NPI Number Information
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NPI Number | 1235319690
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Entity Type | Individual
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Provider Name | BRIAN DARYL BUCKNER L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 15495 SW SEQUOIA PKWY STE. #150
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City | TIGARD
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State | OR
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Zip | 97224-6100
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Country | US
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Telephone | 503-957-0338
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Fax | 503-726-1152
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Provider Business Mailing Address
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Address Line | 15495 SW SEQUOIA PKWY STE. #150
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City | TIGARD
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State | OR
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Zip | 97224-6100
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Country | US
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Telephone | 503-957-0338
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Fax | 503-726-1152
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10755
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License Number State | OR
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