Provider Demographics
NPI:1740365865
Name:BUCKNER, CHRISTOPHER A (MPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:A
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9768
Mailing Address - Country:US
Mailing Address - Phone:937-832-8377
Mailing Address - Fax:
Practice Address - Street 1:2655 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-320-9131
Practice Address - Fax:937-320-9132
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-10273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000307161OtherANTHEM
OH0108341Medicaid
OH38261719350OtherWORKERS COMP
OH366640Medicare ID - Type Unspecified