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Individual
JENNA BUCKWALTER
Active
Individual
JENNA BUCKWALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1732
ND
225100000X
Physical Therapist
Primary
9959
MN
314000000X
Skilled Nursing Facility
9959
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1469913
—
ND
Enumeration date
09/12/2016
Last updated
03/16/2017
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