Provider Demographics
NPI:1235386319
Name:PULVER, VITA FRANCES (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VITA
Middle Name:FRANCES
Last Name:PULVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:REMSENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:11960-0138
Mailing Address - Country:US
Mailing Address - Phone:631-325-6963
Mailing Address - Fax:631-325-2941
Practice Address - Street 1:4 THORNEWOOD CT
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1450
Practice Address - Country:US
Practice Address - Phone:631-878-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics