Provider Demographics
NPI:1871895466
Name:BUDDLE, KARY ELIZABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:KARY
Middle Name:ELIZABETH
Last Name:BUDDLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:KARY
Other - Middle Name:ELIZABETH
Other - Last Name:BUDDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1155 MILLERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13439-4016
Mailing Address - Country:US
Mailing Address - Phone:315-858-0369
Mailing Address - Fax:
Practice Address - Street 1:352 GROS BLVD
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1446
Practice Address - Country:US
Practice Address - Phone:315-867-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002923-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant