Individual
MR. JORDAN LEWIS BUGARSKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 543-5896
(530) 544-6512
Mailing address
PO BOX 9578, SOUTH LAKE TAHOE, CA 96158-9578
(530) 543-5896
(530) 544-6512
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9220
CA
225200000X
Physical Therapy Assistant
A-0930
NV
Other
Enumeration date
11/29/2016
Last updated
03/17/2018
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