MEDICARE: DANIELLE MARIE BUKULA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01409700	NJ

General Provider Information

NPI Number	:	1336437508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE BUKULA PT, DPT

Provider Business Mailing Address
First Line	:	798 ROUTE 539 STE 2
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-4203
Country	:	US
Telephone Number	:	609-294-4720
Fax Number	:	609-294-4722

Provider Business Practice Location Address
First Line	:	798 ROUTE 539 STE 2
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-4203
Country	:	US
Telephone Number	:	609-294-4720
Fax Number	:	609-294-4722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	10/17/2012

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