Provider Demographics
NPI:1275914889
Name:BUCHANAN, KRISTEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MICAH WAY
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-4160
Mailing Address - Country:US
Mailing Address - Phone:256-259-4440
Mailing Address - Fax:
Practice Address - Street 1:102 MICAH WAY
Practice Address - Street 2:SUITE 1105
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-4160
Practice Address - Country:US
Practice Address - Phone:256-259-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist