Provider Demographics
NPI:1114178720
Name:BUCHANAN, RACHEL S (PTA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:S
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:5417 SUFFOLK CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-5497
Mailing Address - Country:US
Mailing Address - Phone:573-579-8537
Mailing Address - Fax:
Practice Address - Street 1:5417 SUFFOLK CIR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5497
Practice Address - Country:US
Practice Address - Phone:573-579-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008021061OtherSTATE LICENSE
AK2143OtherSTATE LICENSE
TX2067760OtherSTATE LICENSE
CO0012959OtherSTATE LICENSE
IL160004948OtherSTATE LICENSE
OK1991OtherSTATE LICENSE