Provider Demographics
NPI:1588819650
Name:BUCHHEIM, DAVE ALAN (MED, PTA)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:ALAN
Last Name:BUCHHEIM
Suffix:
Gender:M
Credentials:MED, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2620 SE KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1454
Mailing Address - Country:US
Mailing Address - Phone:210-789-8694
Mailing Address - Fax:501-637-3737
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6138
Practice Address - Fax:913-684-6104
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant