Provider Demographics
NPI:1457597577
Name:BUNTING, FELISA INOPIQUEZ (PTA)
Entity Type:Individual
Prefix:MRS
First Name:FELISA
Middle Name:INOPIQUEZ
Last Name:BUNTING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6520
Mailing Address - Country:US
Mailing Address - Phone:609-777-9172
Mailing Address - Fax:
Practice Address - Street 1:2300 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3007
Practice Address - Country:US
Practice Address - Phone:609-588-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00263200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant