Provider Demographics
NPI:1154973865
Name:BUCK, KRISTINA (DPT, PT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 LUNAR DR APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4579
Mailing Address - Country:US
Mailing Address - Phone:207-446-3907
Mailing Address - Fax:
Practice Address - Street 1:3190 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7422
Practice Address - Country:US
Practice Address - Phone:907-373-9462
Practice Address - Fax:907-357-7720
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1709946Medicaid