Individual
MALCOLM WENDELL BUCHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
11565 HARTS RD, JACKSONVILLE, FL 32218-3777
(904) 751-1834
Mailing address
11565 HARTS RD, JACKSONVILLE, FL 32218-3777
(352) 215-9878
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
27323
FL
Other
Enumeration date
03/01/2017
Last updated
03/13/2017
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