Justin Buccille
Individual provider Active NPI Physical Therapy Assistant · Siloam Springs, AR
NPI 1134421720 · NPPES record last updated Apr 2, 2013
Key facts
- NPI
- 1134421720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- Practice address
- 918 S Mount Olive St
Siloam Springs, AR 72761-4220 - Phone
- (479) 967-2322
- NPI assigned
- Dec 2, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Friendship Community Care Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | Yes |
Addresses
Primary practice location
918 S Mount Olive St
Siloam Springs, AR 72761-4220
Mailing address
PO Drawer 2109
Russellivlle, AR 72811
Phone (479) 967-2322
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 184894721 | Medicaid | AR |
Other providers in Siloam Springs, AR
- Bright Beginnings Counseling, PLLC
- Daniel Shane Briley
- David Benjamin Brisben
- Alexa Brooks
- Angela M Brown
- Claire Busler
- Amanda E Butler
- Michael J Butler
- Jason M Byrne
- Terra Caldwell
All providers in Siloam Springs, AR · Physical Therapy Assistant in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2013. 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.