Provider Demographics
NPI:1871841072
Name:BUCHANAN, ANTHONY (LMP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 GARFIELD ST
Mailing Address - Street 2:4B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2965
Mailing Address - Country:US
Mailing Address - Phone:509-879-9042
Mailing Address - Fax:
Practice Address - Street 1:465 GARFIELD ST
Practice Address - Street 2:4B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2965
Practice Address - Country:US
Practice Address - Phone:509-879-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA 60267565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist