MEDICARE: MRS. CATHERINE BUCKLEY

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	R0928	MO

General Provider Information

NPI Number	:	1891109138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE BUCKLEY

Provider Business Mailing Address
First Line	:	739 BENT BROOK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-2135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 BENT BROOK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-2135
Country	:	US
Telephone Number	:	314-821-8404
Fax Number	:

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

Provider Enumeration Date	:	06/15/2014
Last Update Date	:	06/15/2014

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Directions to “ MRS. CATHERINE BUCKLEY ” Practice Location

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