Healthcare Provider Details

I. General information

NPI: 1790952315
Provider Name (Legal Business Name): KENNETH R BUCHANAN MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 JOG RD SUITE 100
DELRAY BEACH FL
33446-3808
US

IV. Provider business mailing address

13550 JOG RD SUITE 100
DELRAY BEACH FL
33446-3808
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5144
  • Fax:
Mailing address:
  • Phone: 561-496-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025506-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20239
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: