Provider Demographics
NPI:1619365640
Name:BUCO, WILBERT PUTI
Entity type:Individual
Prefix:
First Name:WILBERT
Middle Name:PUTI
Last Name:BUCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 JOHNSON AVE
Mailing Address - Street 2:APT 1K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3510
Mailing Address - Country:US
Mailing Address - Phone:914-230-6479
Mailing Address - Fax:
Practice Address - Street 1:3225 JOHNSON AVE
Practice Address - Street 2:APT 1K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3510
Practice Address - Country:US
Practice Address - Phone:914-230-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037562-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist