Provider Demographics
NPI:1023058054
Name:BUCKLER, JOAN JARBOE (PT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:JARBOE
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ELLEN
Other - Last Name:JARBOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1771 CANYON SHADOW CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5011
Mailing Address - Country:US
Mailing Address - Phone:775-232-9691
Mailing Address - Fax:
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:PHYSICAL THERAPY DEPT
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-786-7200
Practice Address - Fax:775-337-2260
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOV897P03Medicare ID - Type Unspecified