Provider Demographics
NPI:1043436199
Name:BUCHANAN, JEAN ELLIS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELLIS
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 DEKLEVA DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1725
Mailing Address - Country:US
Mailing Address - Phone:407-880-9568
Mailing Address - Fax:
Practice Address - Street 1:918 DEKLEVA DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-1725
Practice Address - Country:US
Practice Address - Phone:407-880-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19176225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant