Provider Demographics
NPI:1669692299
Name:DAHL-BUSBY, BENTE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:BENTE
Middle Name:
Last Name:DAHL-BUSBY
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 1:108 PRICHARD RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL BRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06754-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 GAY ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2001
Practice Address - Country:US
Practice Address - Phone:860-397-5363
Practice Address - Fax:860-397-5358
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT437134OtherMVP SPECIALIST
CT080004417CT02OtherANTHEM BC BS
NYQ34491OtherEMPIRE BC BS