Provider Demographics
NPI:1225018401
Name:BRUCE, STEPHANIE MEGAN (PT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MEGAN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MEGAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941
Mailing Address - Country:US
Mailing Address - Phone:307-367-6236
Mailing Address - Fax:307-367-3332
Practice Address - Street 1:317 N. FALER AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-367-6236
Practice Address - Fax:307-367-3332
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist