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General NPI Number Information
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NPI Number | 1821476367
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Entity Type | Organization
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Legal Business Name | BUCKEYE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/17/2015
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Last Update Date | 05/17/2015
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Provider Practice Location Address
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Address Line | 4590 S PROFESSIONAL DR UNIT 5102
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City | EDINBURG
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State | TX
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Zip | 78539-6542
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Country | US
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Telephone | 330-770-7596
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Fax | 956-270-4820
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Provider Business Mailing Address
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Address Line | 4590 S PROFESSIONAL DR UNIT 5102
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City | EDINBURG
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State | TX
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Zip | 78539-6542
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Country | US
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Telephone | 330-770-7596
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Fax | 956-270-4820
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JUSTIN C LEMMO
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Credential | DPT
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Telephone | 330-770-7596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1215276
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License Number State | TX
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