Provider Demographics
NPI:1023279106
Name:BUKOVSKY, DESIREE BLAIRE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:BLAIRE
Last Name:BUKOVSKY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:BLAIRE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2312 LIMOUSIN COURT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-589-4709
Mailing Address - Fax:
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-266-3850
Practice Address - Fax:970-266-3855
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22569225100000X
CO9650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist