Provider Demographics
NPI:1326371022
Name:BYNUM, BRUCE LIVINGSTON (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LIVINGSTON
Last Name:BYNUM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 NE 179TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1517
Mailing Address - Country:US
Mailing Address - Phone:305-804-8137
Mailing Address - Fax:
Practice Address - Street 1:1786 NE 179TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1517
Practice Address - Country:US
Practice Address - Phone:305-804-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA3338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist