Provider Demographics
NPI:1114918430
Name:LINDER, BRUCE CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:CHARLES
Last Name:LINDER
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 1:7201 W SAGINAW HWY
Mailing Address - Street 2:STE. 205
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-321-7809
Mailing Address - Fax:517-321-7860
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:STE. 205
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-321-7809
Practice Address - Fax:517-321-7860
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010022172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30674OtherBLUECROSSBLUESHIELD
MI4769029Medicaid
MI64-00009OtherPHYSICIANSHEALTHPLAN
MI4769029Medicaid