Provider Demographics
NPI:1346436011
Name:BUCKWALTER, CAROL ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:BUCKWALTER
Suffix:
Gender:F
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:PO BOX 837
Mailing Address - Street 2:229 VAN SANT AVE
Mailing Address - City:ISLAND HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08732-0837
Mailing Address - Country:US
Mailing Address - Phone:732-330-3935
Mailing Address - Fax:732-929-2954
Practice Address - Street 1:229 VAN SANT AVE
Practice Address - Street 2:
Practice Address - City:ISLAND HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08732-0837
Practice Address - Country:US
Practice Address - Phone:732-330-3935
Practice Address - Fax:732-929-2954
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00738200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043066Medicare PIN