Provider Demographics
NPI:1396909867
Name:BUCHHEISTER, SANDRA B (DPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:BUCHHEISTER
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 1:1913 SAGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3683
Mailing Address - Country:US
Mailing Address - Phone:707-702-2241
Mailing Address - Fax:
Practice Address - Street 1:145 G ST STE E
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6694
Practice Address - Country:US
Practice Address - Phone:707-702-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43586225100000X
VA2305205479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00634360OtherRAILROAD MEDICARE
VA9918179OtherAETNA
VA1396909867Medicaid
VA192960OtherBCBS (PHYSICAL THERAPY)
VA9918179OtherAETNA
VAMC10496Medicare PIN