Provider Demographics
NPI:1104068394
Name:BOKSAN, AUDREY ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ANN
Last Name:BOKSAN
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 1:1287 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-8871
Mailing Address - Country:US
Mailing Address - Phone:717-608-1183
Mailing Address - Fax:
Practice Address - Street 1:755 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9510
Practice Address - Country:US
Practice Address - Phone:717-653-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001663L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant