Provider Demographics
NPI:1093856791
Name:WORLEY, BRUCE MICHAEL SR (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:WORLEY
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2325
Mailing Address - Country:US
Mailing Address - Phone:860-522-2717
Mailing Address - Fax:860-249-6164
Practice Address - Street 1:36 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2325
Practice Address - Country:US
Practice Address - Phone:860-522-2717
Practice Address - Fax:860-249-6164
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist