Provider Demographics
NPI:1467721282
Name:BUCHANAN, VICKY (PT)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
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 1:2400 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9620
Mailing Address - Country:US
Mailing Address - Phone:573-290-5870
Mailing Address - Fax:
Practice Address - Street 1:2400 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9620
Practice Address - Country:US
Practice Address - Phone:573-290-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist