Provider Demographics
NPI:1700100336
Name:BUENASEDA, ERWIN K (PT)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:K
Last Name:BUENASEDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1265 WAYNE AVE STE 308
Mailing Address - Street 2:119 PROFESSIONAL BUILDING
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-081-8095
Mailing Address - Fax:724-801-8147
Practice Address - Street 1:2701 KIRKWOOD HWY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4911
Practice Address - Country:US
Practice Address - Phone:302-668-1768
Practice Address - Fax:302-668-1794
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEJI-0001072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2449064Medicaid
DE2155101OtherHIGHMARK
DE3775507000OtherIBC
DEP01033496OtherMEDIARE RR
DE1700100336Medicaid
DE2155101OtherHIGHMARK