Provider Demographics
NPI:1053427948
Name:BUCKLEY, ANITA A (PT)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:ANN
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:255 GREAT VALLEY PKWY
Practice Address - Street 2:STE 140
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1300
Practice Address - Country:US
Practice Address - Phone:610-981-6411
Practice Address - Fax:610-981-6402
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01101900225100000X
PAPT-020453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1750739OtherPA BLUE SHIELD
PA102567448-0001Medicaid
PA215798VLZMedicare PIN