Provider Demographics
NPI:1487245338
Name:BUCHHOLZ, KURT OTTO (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:OTTO
Last Name:BUCHHOLZ
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-5504
Mailing Address - Country:US
Mailing Address - Phone:978-866-6086
Mailing Address - Fax:
Practice Address - Street 1:245 PHYSICAL EDUCATION BUILDING, WAMS DEPT
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004
Practice Address - Country:US
Practice Address - Phone:978-866-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1611161832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer