Provider Demographics
NPI:1487951018
Name:BUCHANAN, ELAINE (PTA)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 S NORMAL BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2633
Mailing Address - Country:US
Mailing Address - Phone:773-971-7744
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-9466
Practice Address - Country:US
Practice Address - Phone:815-468-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000123106H00000X
IN06003842A225200000X
NVA0990225200000X
IL160004968225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist