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Individual
MR. ANDREW PAUL BUCKO
Active
Individual
MR. ANDREW PAUL BUCKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J3-0000512
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000015396
BOC
—
01
—
J3-0000512
STATE ATHLETIC TRAINING LICENSE
PA
Enumeration date
08/14/2019
Last updated
08/14/2019
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