Deidre M Buckingham, PTA, LMT
Massage Therapist in Madison, WI. Individual provider (NPI-1).
NPI number1164582771
StatusActive
Last updated in NPPESAug 18, 2021
Details
- NPI
- 1164582771
- Entity type
- Individual (NPI-1)
- Name
- Deidre M Buckingham
- Credential
- PTA, LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 12, 2006
- Certification date
- Mar 25, 2021
- Last updated
- Aug 18, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 724-146 | WI | Yes |
| 225200000X | Physical Therapy Assistant | 1353-019 | WI |
Practice location
1915 Winnebago StMadison, WI 53704-5305
Phone 608-301-5717 · Fax 608-200-3270
Mailing address
727 Saint Johns AveMilton, WI 53563-1692
Phone 608-332-1032 · Fax 608-200-3270
Other practice locations
4602 East Park Boulevard East Wing Mail Code Ac10
Madison, WI 53792-0001
Madison, WI 53792-0001
Phone 608-262-9355
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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