Provider Demographics
NPI:1992763593
Name:BOKOR, JUDITH MARIE (MPT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:BOKOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:BURGSTAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 E 72ND ST
Mailing Address - Street 2:STE A100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-5906
Mailing Address - Country:US
Mailing Address - Phone:253-853-7956
Mailing Address - Fax:253-853-7958
Practice Address - Street 1:1407 E 72ND ST
Practice Address - Street 2:STE A100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-5906
Practice Address - Country:US
Practice Address - Phone:253-759-4200
Practice Address - Fax:253-759-5017
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341976Medicaid
WA8802551Medicare ID - Type Unspecified
WA8802549Medicare ID - Type Unspecified