Provider Demographics
NPI:1316263965
Name:BUCK, ELIZABETH MARTINA (LMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARTINA
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 1:627 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4248
Mailing Address - Country:US
Mailing Address - Phone:425-367-1365
Mailing Address - Fax:
Practice Address - Street 1:2010 FAIR PARK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-931-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist