Provider Demographics
NPI:1104197367
Name:BRUCE, PERRY D (PT)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:D
Last Name:BRUCE
Suffix:
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 1:5928 COVEVIEW DR W
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4815
Mailing Address - Country:US
Mailing Address - Phone:863-937-4770
Mailing Address - Fax:
Practice Address - Street 1:3110 OAKBRIDGE BLVD E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5987
Practice Address - Country:US
Practice Address - Phone:863-648-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist