Provider Demographics
NPI:1841841731
Name:BUCKLEY, WILLIAM RYALL JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYALL
Last Name:BUCKLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST UNIT 9L
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3457
Mailing Address - Country:US
Mailing Address - Phone:603-553-2624
Mailing Address - Fax:
Practice Address - Street 1:875 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4229
Practice Address - Country:US
Practice Address - Phone:603-610-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer