Provider Demographics
NPI:1790752962
Name:BUKOWSKI, ELAINE LOUISE (PT)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:LOUISE
Last Name:BUKOWSKI
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 1:439 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-4944
Mailing Address - Country:US
Mailing Address - Phone:609-926-1007
Mailing Address - Fax:
Practice Address - Street 1:439 SUPERIOR RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4944
Practice Address - Country:US
Practice Address - Phone:609-926-1007
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00263600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist