Provider Demographics
NPI:1154073518
Name:BUSKIRK, DAWN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 SAINT JOE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-3380
Mailing Address - Country:US
Mailing Address - Phone:260-418-6778
Mailing Address - Fax:
Practice Address - Street 1:5202 SAINT JOE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3380
Practice Address - Country:US
Practice Address - Phone:260-492-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004537A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant