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General NPI Number Information
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NPI Number | 1316263965
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Entity Type | Individual
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Provider Name | ELIZABETH MARTINA BUCK LMT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 2010 FAIR PARK BLVD SUITE F
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-931-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 627 W COURT ST
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City | PARAGOULD
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State | AR
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Zip | 72450-4248
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Country | US
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Telephone | 425-367-1365
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Fax |
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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 | 8393
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License Number State | AR
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