Provider Demographics
NPI:1932645751
Name:BUCHANAN, DAVID (PTA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COLLINS RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38581-3685
Mailing Address - Country:US
Mailing Address - Phone:615-766-7067
Mailing Address - Fax:
Practice Address - Street 1:34 GRACEY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2046
Practice Address - Country:US
Practice Address - Phone:913-836-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant