Healthcare Provider Details

I. General information

NPI: 1275023681
Provider Name (Legal Business Name): KATIE DANIELS BUYNISKI DPT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 RIDGE RD
MUNSTER IN
46321-1610
US

IV. Provider business mailing address

1440 FISHER ST
MUNSTER IN
46321-2607
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-7473
  • Fax: 219-444-4518
Mailing address:
  • Phone: 219-629-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE DANIELS BUYNISKI
Title or Position: PRESIDENT
Credential:
Phone: 219-629-4076