Kelly Buckman, PTA
Individual provider Active NPI Physical Therapy Assistant · Council Bluffs, IA
NPI 1003219973 · NPPES record last updated Oct 6, 2014
Key facts
- NPI
- 1003219973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 004861 (IA)
- Practice address
- 201 W Broadway
Council Bluffs, IA 51503-9004 - Phone
- (712) 329-9419
- Fax
- (712) 329-0329
- NPI assigned
- Oct 6, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004861 | IA | MD | Physical Therapy Assistant |
| 1107 | NE | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 004861 | IA | Yes |
| Physical Therapy Assistant | 225200000X | 1107 | NE |
Addresses
Primary practice location
201 W Broadway
Council Bluffs, IA 51503-9004
Mailing address
201 W Broadway
Council Bluffs, IA 51503-9004
Phone (712) 329-9419
Other providers in Council Bluffs, IA
- Ashlyn Nichole Brown
- Mikayla Brown
- Rosa Brown
- Zachary Dylan Brown
- Bridget L Buck
- Ryan Gerald Buetow
- Brianne Buge
- Phuong Cat Bui
- Shalenna F Burgess
- Alexandria Gabrellia Burk
All providers in Council Bluffs, IA · Physical Therapy Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.