Provider Demographics
NPI:1174402564
Name:BUCHANAN, PHILIP W (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GARY RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2417
Mailing Address - Country:US
Mailing Address - Phone:617-832-5680
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON ST STE 422
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2402
Practice Address - Country:US
Practice Address - Phone:617-732-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist