Provider Demographics
NPI:1073891602
Name:BUYNISKI, KATHERINE DANIELS (PT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DANIELS
Last Name:BUYNISKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2607
Mailing Address - Country:US
Mailing Address - Phone:219-629-4076
Mailing Address - Fax:
Practice Address - Street 1:1440 FISHER ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2607
Practice Address - Country:US
Practice Address - Phone:219-629-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist