Provider Demographics
NPI:1720220056
Name:BOUSQUET, AMANDA F (MS, PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:F
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 W. MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646
Mailing Address - Country:US
Mailing Address - Phone:201-244-6625
Mailing Address - Fax:
Practice Address - Street 1:219 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2517
Practice Address - Country:US
Practice Address - Phone:201-907-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01238800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist