Provider Demographics
NPI:1063173003
Name:BUCK, JOANNE CAROL (LMT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:CAROL
Last Name:BUCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 COUPON GALLITZIN RD
Mailing Address - Street 2:
Mailing Address - City:COUPON
Mailing Address - State:PA
Mailing Address - Zip Code:16629-8429
Mailing Address - Country:US
Mailing Address - Phone:814-330-8757
Mailing Address - Fax:
Practice Address - Street 1:2900 PLANK RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-9361
Practice Address - Country:US
Practice Address - Phone:814-946-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist