Healthcare Provider Details

I. General information

NPI: 1700100336
Provider Name (Legal Business Name): ERWIN K BUENASEDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 KIRKWOOD HWY LOWER LEVEL
WILMINGTON DE
19805-4911
US

IV. Provider business mailing address

1265 WAYNE AVE STE 308 119 PROFESSIONAL BUILDING
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 302-668-1768
  • Fax: 302-668-1794
Mailing address:
  • Phone: 724-081-8095
  • Fax: 724-801-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJI-0001072
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: