Provider Demographics
NPI:1689861338
Name:BUCKNER, ANNA KATIE (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATIE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATIE
Other - Last Name:ELLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1076 W CHANDLER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5223
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:1076 W CHANDLER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5223
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-1887
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3027225100000X, 2251X0800X
AZ13331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic