Provider Demographics
NPI:1396207452
Name:VANCLEAVE, BRUNA MARIA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BRUNA
Middle Name:MARIA
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:BRUNA
Other - Middle Name:MARIA
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:1130 WEST WOODMEN ROAD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-574-5562
Mailing Address - Fax:719-471-0445
Practice Address - Street 1:1130 WEST WOODMEN ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-574-5562
Practice Address - Fax:719-471-0445
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist