Provider Demographics
NPI:1235404955
Name:BRUGGEMAN, MOLLY E (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:BRUGGEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 JOHNSON RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8936
Mailing Address - Country:US
Mailing Address - Phone:724-223-2061
Mailing Address - Fax:724-223-2064
Practice Address - Street 1:2490 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4236
Practice Address - Country:US
Practice Address - Phone:412-717-3975
Practice Address - Fax:412-717-3979
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PAPT024573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer