Provider Demographics
NPI:1073360335
Name:BUKER, JULIE (PTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BUKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-3203
Mailing Address - Country:US
Mailing Address - Phone:360-624-0962
Mailing Address - Fax:
Practice Address - Street 1:2041 ROSECRANS AVE STE 245
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-7509
Practice Address - Country:US
Practice Address - Phone:888-223-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8243225200000X
NMPTA1981225200000X
WAP160038835225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant