Individual
DEIDRE M BUCKINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
1915 WINNEBAGO ST, MADISON, WI 53704-5305
(608) 301-5717
(608) 200-3270
Mailing address
727 SAINT JOHNS AVE, MILTON, WI 53563-1692
(608) 332-1032
(608) 200-3270
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1353-019
WI
225700000X
Massage Therapist
Primary
724-146
WI
Other
Enumeration date
12/12/2006
Last updated
08/18/2021
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