Provider Demographics
NPI:1336491620
Name:BRUCE, ADAM J (PHD)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:BRUCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RIVER FERN AVE
Mailing Address - Street 2:#1424
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2999
Mailing Address - Country:US
Mailing Address - Phone:409-692-7771
Mailing Address - Fax:
Practice Address - Street 1:3136 HORIZON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7807
Practice Address - Country:US
Practice Address - Phone:972-475-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist