Provider Demographics
NPI:1639104938
Name:BUCHNER, KRISTEN BROADWAY (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BROADWAY
Last Name:BUCHNER
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 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-4415
Mailing Address - Fax:334-953-6646
Practice Address - Street 1:42ND MEDICAL GROUP
Practice Address - Street 2:300 S. TWINING STREET
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-4415
Practice Address - Fax:334-953-6646
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3856225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533661OtherBCBS
AL515-33661OtherBLUE CROSS BLUE SHEILD
AL19661Medicare UPIN
AL051559129Medicare PIN