Provider Demographics
NPI:1124155445
Name:BUCHALTER, LEIGH (PT)
Entity type:Individual
Prefix:MR
First Name:LEIGH
Middle Name:
Last Name:BUCHALTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 N UNIVERSITY DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2153
Mailing Address - Country:US
Mailing Address - Phone:954-724-5500
Mailing Address - Fax:954-724-5131
Practice Address - Street 1:8010 N UNIVERSITY DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2153
Practice Address - Country:US
Practice Address - Phone:954-724-5500
Practice Address - Fax:954-724-5131
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0005582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2786ZMedicare ID - Type Unspecified