Healthcare Provider Details

I. General information

NPI: 1790350668
Provider Name (Legal Business Name): DANIEL BUKUNUS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CLARK ST
OVIEDO FL
32765-7378
US

IV. Provider business mailing address

1516 ELF STONE CT
CASSELBERRY FL
32707-5938
US

V. Phone/Fax

Practice location:
  • Phone: 407-359-5693
  • Fax: 407-792-5693
Mailing address:
  • Phone: 352-638-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: