Healthcare Provider Details

I. General information

NPI: 1437126588
Provider Name (Legal Business Name): JOHN KYLE BUCHANAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24902 MOULTON PKWY SUITE 200
LAGUNA HILLS CA
92637-6410
US

IV. Provider business mailing address

12431 MAGNOLIA ST
GARDEN GROVE CA
92841-3321
US

V. Phone/Fax

Practice location:
  • Phone: 949-462-0560
  • Fax: 949-462-3910
Mailing address:
  • Phone: 949-462-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: