Provider Demographics
NPI:1942633953
Name:BUCH, GABRIELLE ALEXANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXANDRA
Last Name:BUCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 W APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9340
Mailing Address - Country:US
Mailing Address - Phone:208-762-2100
Mailing Address - Fax:208-762-2101
Practice Address - Street 1:5605 100TH ST SW
Practice Address - Street 2:STE B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2710
Practice Address - Country:US
Practice Address - Phone:253-284-9800
Practice Address - Fax:360-704-7676
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60397526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist