Provider Demographics
NPI:1598801334
Name:PRUCKLER, BONNIE HIBMA (PT)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:HIBMA
Last Name:PRUCKLER
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 1:2221 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-1379
Mailing Address - Country:US
Mailing Address - Phone:319-277-5440
Mailing Address - Fax:
Practice Address - Street 1:3706 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6207
Practice Address - Country:US
Practice Address - Phone:319-273-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00785251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)