Provider Demographics
NPI:1376519603
Name:BRUBECK, BRUCE J (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:J
Last Name:BRUBECK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6044
Mailing Address - Country:US
Mailing Address - Phone:541-683-5139
Mailing Address - Fax:541-683-5783
Practice Address - Street 1:911 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 150
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6044
Practice Address - Country:US
Practice Address - Phone:541-683-5139
Practice Address - Fax:541-683-5783
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131801Medicare PIN