MEDICARE: ANTHONY JOSEPH BUKOWSKI PTA

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	225200000X	Physical Therapy Assistant	PTA30321	FL

General Provider Information

NPI Number	:	1538744909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JOSEPH BUKOWSKI PTA

Provider Business Mailing Address
First Line	:	703 JACARANDA DR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4545
Country	:	US
Telephone Number	:	813-854-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 22ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-3004
Country	:	US
Telephone Number	:	727-894-5125
Fax Number	:

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

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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