Provider Demographics
NPI:1619350204
Name:BUCKALEW, LAUREN C (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:C
Last Name:BUCKALEW
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 1:610 LURLEEN B WALLACE BLVD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1713
Mailing Address - Country:US
Mailing Address - Phone:205-409-8060
Mailing Address - Fax:205-737-8841
Practice Address - Street 1:401 5TH AVE E
Practice Address - Street 2:STE 106
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-3904
Practice Address - Fax:205-348-4980
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5550225100000X
ALPTH7752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist