Provider Demographics
NPI:1396178935
Name:BUCHANAN, BETH ANN (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14560 LAKESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1350
Mailing Address - Country:US
Mailing Address - Phone:586-566-6146
Mailing Address - Fax:586-532-8431
Practice Address - Street 1:14560 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1350
Practice Address - Country:US
Practice Address - Phone:586-566-6146
Practice Address - Fax:586-532-8431
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist