Provider Demographics
NPI:1235453895
Name:POMMERENING, BRUCE E (CMT, CR)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:POMMERENING
Suffix:
Gender:M
Credentials:CMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 BUTTERNUT DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1517
Mailing Address - Country:US
Mailing Address - Phone:616-796-4618
Mailing Address - Fax:
Practice Address - Street 1:868 BUTTERNUT DR
Practice Address - Street 2:OFFICE ENTRANCE
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1517
Practice Address - Country:US
Practice Address - Phone:616-796-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00425OtherBUREAU OF PROFESSIONAL LICENSURE