Provider Demographics
NPI:1447298203
Name:BUCHANAN, DIANE MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 ALTON WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3116
Mailing Address - Country:US
Mailing Address - Phone:856-374-1068
Mailing Address - Fax:856-374-1102
Practice Address - Street 1:5 ALTON WAY
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3116
Practice Address - Country:US
Practice Address - Phone:856-374-1068
Practice Address - Fax:856-374-1102
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00890200225100000X
PAPT0005702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist