Provider Demographics
NPI:1477687150
Name:BUCHANAN, ELLEN C (LPT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:C
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2156
Mailing Address - Country:US
Mailing Address - Phone:708-771-5748
Mailing Address - Fax:708-771-5748
Practice Address - Street 1:1021 TROOST AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2156
Practice Address - Country:US
Practice Address - Phone:708-771-5748
Practice Address - Fax:708-771-5748
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635289Medicare UPIN