Provider Demographics
NPI:1528950128
Name:BUCKHOLZ, SALLY R
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:R
Last Name:BUCKHOLZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PAMPAS ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-7709
Mailing Address - Country:US
Mailing Address - Phone:209-484-5723
Mailing Address - Fax:
Practice Address - Street 1:913 NE WOODS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1989
Practice Address - Country:US
Practice Address - Phone:913-632-4795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist