Provider Demographics
NPI:1922287937
Name:BUCKENDAHL, SARAH KAY (PT, MPT, GCS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAY
Last Name:BUCKENDAHL
Suffix:
Gender:F
Credentials:PT, MPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0069
Mailing Address - Country:US
Mailing Address - Phone:702-346-3105
Mailing Address - Fax:
Practice Address - Street 1:210 N SANDHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4789
Practice Address - Country:US
Practice Address - Phone:702-346-3105
Practice Address - Fax:702-346-3544
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist