Provider Demographics
NPI:1083028096
Name:GRUMBLEY, BUFFI MAKANALANI (PTA)
Entity Type:Individual
Prefix:
First Name:BUFFI
Middle Name:MAKANALANI
Last Name:GRUMBLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MAKANA
Other - Middle Name:
Other - Last Name:GRUMBLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:88072 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9708
Mailing Address - Country:US
Mailing Address - Phone:541-704-8041
Mailing Address - Fax:
Practice Address - Street 1:488 E 11TH AVE # 150A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3601
Practice Address - Country:US
Practice Address - Phone:541-505-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08959225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant