Provider Demographics
NPI:1154913226
Name:BUENAFE, BRYAN (PT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BUENAFE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TIMMERMAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8493
Mailing Address - Country:US
Mailing Address - Phone:917-783-2029
Mailing Address - Fax:
Practice Address - Street 1:113 TIMMERMAN DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8493
Practice Address - Country:US
Practice Address - Phone:917-783-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT611129902251G0304X
NY0457662251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics