Provider Demographics
NPI:1386033918
Name:PIVOTAL CONNECTIONS LLC
Entity Type:Organization
Organization Name:PIVOTAL CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUCHHEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-232-9877
Mailing Address - Street 1:3051 LITTLE POND ST
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9476
Mailing Address - Country:US
Mailing Address - Phone:757-232-9877
Mailing Address - Fax:
Practice Address - Street 1:22378 THREE NOTCH RD UNIT B
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2003
Practice Address - Country:US
Practice Address - Phone:757-232-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24712261QP2000X
CA43586261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy