Provider Demographics
NPI:1821543190
Name:BUCKNELL, REYNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:REYNA
Middle Name:
Last Name:BUCKNELL
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 1:3320 N STOCKTON HILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3611
Mailing Address - Country:US
Mailing Address - Phone:407-376-1404
Mailing Address - Fax:
Practice Address - Street 1:3320 N STOCKTON HILL RD STE C
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3611
Practice Address - Country:US
Practice Address - Phone:407-376-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist