Provider Demographics
NPI:1396338406
Name:BUZBEE, THOMAS (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BUZBEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ENID LN
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2452
Mailing Address - Country:US
Mailing Address - Phone:405-207-3871
Mailing Address - Fax:
Practice Address - Street 1:872 COLLEGE BLVD # 8408
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8408
Practice Address - Country:US
Practice Address - Phone:573-302-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist