Basic Information
| Provider Information | |||||||||
| NPI: | 1942633953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCH | ||||||||
| FirstName: | GABRIELLE | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2726 W APPERSON DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838159340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087622100 | ||||||||
| FaxNumber: | 2087622101 | ||||||||
| Practice Location | |||||||||
| Address1: | 5605 100TH ST SW | ||||||||
| Address2: | STE B | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984992710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532849800 | ||||||||
| FaxNumber: | 3607047676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60397526 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.