Healthcare Provider Details

I. General information

NPI: 1396429734
Provider Name (Legal Business Name): JOSEPH MICHAEL BUKOSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 WARM SPRINGS AVE
HUNTINGDON PA
16652-2350
US

IV. Provider business mailing address

161 MULLIGAN DR
HOLLIDAYSBURG PA
16648-9288
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-4210
  • Fax:
Mailing address:
  • Phone: 814-932-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012165L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: