Provider Demographics
NPI:1730077819
Name:BUCKNAM, ANSLEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANSLEY
Middle Name:
Last Name:BUCKNAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 E EASTER CIR S
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2033
Mailing Address - Country:US
Mailing Address - Phone:843-901-0985
Mailing Address - Fax:
Practice Address - Street 1:7405 W ARIZONA PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5416
Practice Address - Country:US
Practice Address - Phone:303-720-4244
Practice Address - Fax:303-353-1779
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0020596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist