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General NPI Number Information
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NPI Number | 1487951018
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Entity Type | Individual
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Provider Name | ELAINE BUCHANAN PTA
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Gender | Female
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 1 VETERANS DR
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City | MANTENO
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State | IL
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Zip | 60950-9466
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Country | US
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Telephone | 815-468-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 6550 S NORMAL BLVD FL 1
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City | CHICAGO
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State | IL
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Zip | 60621-2633
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Country | US
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Telephone | 773-971-7744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.000123
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003842A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A0990
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160004968
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License Number State | IL
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