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NPI Code Detail

MEDICARE: RAVEN BUCKNER

MEDICARE: RAVEN BUCKNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1369923TX

General Provider Information

NPI Number : 1629799440
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN BUCKNER
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-558-0076
Fax Number :
Provider Business Practice Location Address
First Line : 26084 NORTHWEST FWY STE 140
Second Line :
City : CYPRESS
State : TX
Zip : 77429-1003
Country : US
Telephone Number : 832-349-1168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2022
Last Update Date : 01/30/2026

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Directions to “ RAVEN BUCKNER ” Practice Location

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