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KIM MICHELLE BUCKO OTR

Physical Therapy >> Clinic/Center >> Ambulatory Health Care Facilities

Registrant NPI Number: 1922358266

Individual Registrant:
 KIM MICHELLE BUCKO OTR
Gender: F
Sole Proprietor

Location and contact information for practice:
2440 GOLD STAR HWY SUITE 201 MYSTIC, CT 06355-1180 US
Tel: 860-536-1001  Fax: --

Contact information for business:
18 UPPER KENSINGTON DR  EAST LYME, CT 06333-1164 US
Tel: 860-451-8623  Fax: --

Registration Information:
NPI: 1922358266
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QP2000XAmbulatory Health Care Facilities
Clinic/Center
Physical Therapy
CT001892

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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