Provider Demographics
NPI:1659586014
Name:BULTHAUP, GINGER DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:DENISE
Last Name:BULTHAUP
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 94
Mailing Address - Street 2:
Mailing Address - City:FARMLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47340-0094
Mailing Address - Country:US
Mailing Address - Phone:765-468-6043
Mailing Address - Fax:
Practice Address - Street 1:501 N. MORRIS ST.
Practice Address - Street 2:
Practice Address - City:FARMLAND
Practice Address - State:IN
Practice Address - Zip Code:47340-0094
Practice Address - Country:US
Practice Address - Phone:765-468-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002646A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant