Individual
BONIFACIO WENCESLAO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2656 SOUTH RD STE C, POUGHKEEPSIE, NY 12601-5279
(845) 849-1082
Mailing address
2656 SOUTH RD STE C, POUGHKEEPSIE, NY 12601-5279
(845) 849-1082
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
032312
NY
225100000X
Physical Therapist
Primary
032312
NY
Other
Enumeration date
04/05/2012
Last updated
02/04/2021
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