Provider Demographics
NPI:1376818765
Name:BUKREY, JULIE KRISTINE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KRISTINE
Last Name:BUKREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-8410
Mailing Address - Country:US
Mailing Address - Phone:616-997-2929
Mailing Address - Fax:
Practice Address - Street 1:391 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-8410
Practice Address - Country:US
Practice Address - Phone:616-997-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist