Provider Demographics
NPI:1447495304
Name:BUCHOLZ, BRACHA S (PT)
Entity type:Individual
Prefix:
First Name:BRACHA
Middle Name:S
Last Name:BUCHOLZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3336
Mailing Address - Country:US
Mailing Address - Phone:347-248-3184
Mailing Address - Fax:973-777-2324
Practice Address - Street 1:29 IDAHO ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3336
Practice Address - Country:US
Practice Address - Phone:347-248-3184
Practice Address - Fax:973-777-2324
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023591-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist