Provider Demographics
NPI:1043307614
Name:FILLER, BRUCE DAVID
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DAVID
Last Name:FILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 TWO NOTCH RD
Mailing Address - Street 2:COLUMBIA REHABILITATION CLINIC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2257
Mailing Address - Country:US
Mailing Address - Phone:803-799-7007
Mailing Address - Fax:803-256-8410
Practice Address - Street 1:2362 TWO NOTCH RD
Practice Address - Street 2:COLUMBIA REHABILITATION CLINIC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2257
Practice Address - Country:US
Practice Address - Phone:803-799-7007
Practice Address - Fax:803-256-8410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC387208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1590Medicaid
Q23115Medicare UPIN