Provider Demographics
NPI:1447242847
Name:BUCHHEISTER, KLEMENTINA TINA (PT)
Entity Type:Individual
Prefix:
First Name:KLEMENTINA
Middle Name:TINA
Last Name:BUCHHEISTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 RENAISSANCE TOWNE DR
Mailing Address - Street 2:STE 350
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7667
Mailing Address - Country:US
Mailing Address - Phone:801-295-3553
Mailing Address - Fax:801-295-3599
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:STE 350
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-3553
Practice Address - Fax:801-295-3599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4910337 2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist