Provider Demographics
NPI:1578796595
Name:BUFFONE, CHRISTINE ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:BUFFONE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:5708 75TH ST
Practice Address - Street 2:B
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3635
Practice Address - Country:US
Practice Address - Phone:262-697-9135
Practice Address - Fax:262-697-9175
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11215-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist