Healthcare Provider Details

I. General information

NPI: 1720220056
Provider Name (Legal Business Name): AMANDA F BOUSQUET MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RICHMOND AVE
NEW MILFORD NJ
07646-2517
US

IV. Provider business mailing address

259 W. MADISON AVENUE
NEW MILFORD NJ
07646
US

V. Phone/Fax

Practice location:
  • Phone: 201-907-3150
  • Fax:
Mailing address:
  • Phone: 201-244-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01238800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: