Provider Demographics
NPI:1205266814
Name:BOUY, DAVID (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOUY
Suffix:
Gender:M
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:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07602-1125
Mailing Address - Country:US
Mailing Address - Phone:509-560-9406
Mailing Address - Fax:
Practice Address - Street 1:20 BANTA PL
Practice Address - Street 2:STE 111
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5606
Practice Address - Country:US
Practice Address - Phone:509-560-9406
Practice Address - Fax:201-334-9815
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA015012002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ239640Medicare UPIN