Provider Demographics
NPI:1417389685
Name:BUCKNER, DAVID JAMES (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4154
Mailing Address - Country:US
Mailing Address - Phone:985-641-2996
Mailing Address - Fax:985-639-8014
Practice Address - Street 1:200 N MILITARY RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1624
Practice Address - Country:US
Practice Address - Phone:985-641-2996
Practice Address - Fax:985-639-8014
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist