Provider Demographics
NPI:1205398906
Name:BUCKNOR, DEANDRA MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DEANDRA
Middle Name:MARIE
Last Name:BUCKNOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 NW 71ST WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2207
Mailing Address - Country:US
Mailing Address - Phone:954-609-1897
Mailing Address - Fax:
Practice Address - Street 1:11947 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7619
Practice Address - Country:US
Practice Address - Phone:561-204-2213
Practice Address - Fax:561-204-2218
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist