Provider Demographics
NPI:1558537043
Name:BUZZARD, DEBORAH JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:BUZZARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:131 BALBRIGGAN DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5756
Mailing Address - Country:US
Mailing Address - Phone:843-863-0416
Mailing Address - Fax:843-863-0416
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:FORT DEFIANCE INDIAN HOSPITAL
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:96504-0649
Practice Address - Country:US
Practice Address - Phone:928-729-8132
Practice Address - Fax:928-729-8019
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000816A225100000X
SC2358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist