Provider Demographics
NPI:1053007641
Name:BUFFA, GRAZIA (PTA, NBC-HWC)
Entity type:Individual
Prefix:
First Name:GRAZIA
Middle Name:
Last Name:BUFFA
Suffix:
Gender:F
Credentials:PTA, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54642 HIBISCUS DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2263
Mailing Address - Country:US
Mailing Address - Phone:586-246-1123
Mailing Address - Fax:
Practice Address - Street 1:54642 HIBISCUS DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2263
Practice Address - Country:US
Practice Address - Phone:586-246-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002045225200000X
MIA-3694981171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant