Provider Demographics
NPI:1881847697
Name:BUNKER, HEATHER ANN (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:BUNKER
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 1:22 COHO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-4610
Mailing Address - Country:US
Mailing Address - Phone:315-528-4664
Mailing Address - Fax:
Practice Address - Street 1:1005 W FAYETTE ST FL 4
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2860
Practice Address - Country:US
Practice Address - Phone:315-435-4276
Practice Address - Fax:315-435-6539
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029589-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist