MEDICARE: MR. CARY C BUCKO PT MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5747	AZ

General Provider Information

NPI Number	:	1881783603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARY C BUCKO PT MPT

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:	623-434-6164

Provider Business Practice Location Address
First Line	:	6320B W UNION HILLS DR
Second Line	:	SUITE 2200
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7201
Country	:	US
Telephone Number	:	623-561-3103
Fax Number	:	623-561-3106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/26/2015

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