Provider Demographics
NPI:1023545423
Name:BUFFINGTON, JACY RAE (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:RAE
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12737 BROWN JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-6002
Mailing Address - Country:US
Mailing Address - Phone:605-375-3855
Mailing Address - Fax:
Practice Address - Street 1:510 1ST ST E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720
Practice Address - Country:US
Practice Address - Phone:605-375-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1976208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation