Provider Demographics
NPI:1003088188
Name:RUZICH, BRANDI N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:N
Last Name:RUZICH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N. MADISON
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363
Mailing Address - Country:US
Mailing Address - Phone:217-285-9601
Mailing Address - Fax:
Practice Address - Street 1:320 N. MADISON
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363
Practice Address - Country:US
Practice Address - Phone:217-285-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
070016293OtherILLINOIS LICENSE NUMBER
070016293OtherILLINOIS LICENSE NUMBER
IL634650113Medicare PIN