Provider Demographics
NPI:1598107831
Name:BUONOMO, HAILY N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HAILY
Middle Name:N
Last Name:BUONOMO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 HERMANCE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9330
Mailing Address - Country:US
Mailing Address - Phone:585-520-9669
Mailing Address - Fax:
Practice Address - Street 1:1580 HERMANCE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9330
Practice Address - Country:US
Practice Address - Phone:585-520-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022521225100000X
NY035372-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist