Provider Demographics
NPI:1053939694
Name:BUCK, ANDREA N (DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:N
Last Name:BUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:N
Other - Last Name:KIMMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:596 ASHCROFT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4179
Mailing Address - Country:US
Mailing Address - Phone:757-561-9472
Mailing Address - Fax:
Practice Address - Street 1:350 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5024
Practice Address - Country:US
Practice Address - Phone:904-853-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist