Healthcare Provider Details

I. General information

NPI: 1588819650
Provider Name (Legal Business Name): DAVE ALAN BUCHHEIM M.ED., PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

2620 SE KENTUCKY AVE
TOPEKA KS
66605-1454
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6138
  • Fax: 913-684-6104
Mailing address:
  • Phone: 210-789-8694
  • Fax: 501-637-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberT-02328
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: