Provider Demographics
NPI:1144439670
Name:BUZZAS, VINCENT CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:CHARLES
Last Name:BUZZAS
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 1:715 KENSINGTON AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5769
Mailing Address - Country:US
Mailing Address - Phone:406-549-4646
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINGTON AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5769
Practice Address - Country:US
Practice Address - Phone:406-549-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT03-00089-0OtherMT. STATEFUND(WORKERSCOMP
MT34-1835Medicaid
MT6035-0OtherBLUECROSSBLUESHIELD,MT
MT6035-0OtherBLUECROSSBLUESHIELD,MT