Provider Demographics
NPI:1497043426
Name:BUYEA, DANIELLE ALEXIS (LMT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALEXIS
Last Name:BUYEA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ALEXIS
Other - Last Name:BOTTARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 79TH TER N
Mailing Address - Street 2:311
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4392
Mailing Address - Country:US
Mailing Address - Phone:727-600-2827
Mailing Address - Fax:
Practice Address - Street 1:680 79TH TER N
Practice Address - Street 2:311
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4392
Practice Address - Country:US
Practice Address - Phone:727-600-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56672225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist