Provider Demographics
NPI:1679088678
Name:BUCHANAN, ZACHARY PORTER (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:PORTER
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:MR
Other - First Name:ZACK
Other - Middle Name:PORTER
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1738 SOTO ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5542
Mailing Address - Country:US
Mailing Address - Phone:707-980-1977
Mailing Address - Fax:
Practice Address - Street 1:2185 CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:442-281-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist