Provider Demographics
NPI:1104984905
Name:HALEY, BUFFIE L (DPT)
Entity type:Individual
Prefix:
First Name:BUFFIE
Middle Name:L
Last Name:HALEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1078
Mailing Address - Country:US
Mailing Address - Phone:585-798-4344
Mailing Address - Fax:585-798-0439
Practice Address - Street 1:711 PARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1078
Practice Address - Country:US
Practice Address - Phone:585-798-4344
Practice Address - Fax:585-798-0439
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017673-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist