Provider Demographics
NPI:1326149667
Name:BRUCE, RANDY CLAIR (MSPT)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:CLAIR
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1572
Mailing Address - Country:US
Mailing Address - Phone:509-766-4277
Mailing Address - Fax:509-766-4280
Practice Address - Street 1:515 N STRATFORD RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1572
Practice Address - Country:US
Practice Address - Phone:509-766-4277
Practice Address - Fax:509-766-4280
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA51945OtherWORK HARDENING L&I
WA0051945OtherLABOR AND INDUSTRY/PT
WA7062011Medicaid
WAAB22949Medicare ID - Type UnspecifiedPHYSICAL THERAPY