Provider Demographics
NPI:1104114180
Name:BUENVIAJE, JOYCE CONCEPCION (PTA)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:CONCEPCION
Last Name:BUENVIAJE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:FRANCISCO
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:12105 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3642
Mailing Address - Country:US
Mailing Address - Phone:719-481-9494
Mailing Address - Fax:
Practice Address - Street 1:12105 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3642
Practice Address - Country:US
Practice Address - Phone:719-481-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006832225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant