Provider Demographics
NPI:1215286877
Name:BUCHANAN, ALICE L (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:L
Other - Last Name:DEMYANICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2452 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2404
Mailing Address - Country:US
Mailing Address - Phone:330-926-9003
Mailing Address - Fax:
Practice Address - Street 1:2452 7TH ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2404
Practice Address - Country:US
Practice Address - Phone:330-926-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist