Provider Demographics
NPI:1134129968
Name:BUZZELL, KATE A (PT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:A
Last Name:BUZZELL
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 1:100 FODEN RD
Mailing Address - Street 2:SUITE 103W
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2319
Mailing Address - Country:US
Mailing Address - Phone:207-772-2625
Mailing Address - Fax:207-892-7642
Practice Address - Street 1:100 FODEN RD
Practice Address - Street 2:SUITE 103W
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2319
Practice Address - Country:US
Practice Address - Phone:207-772-2625
Practice Address - Fax:207-892-7642
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060630OtherBC/BS OF MAINE
MEMM9052Medicare ID - Type Unspecified