Provider Demographics
NPI:1407285471
Name:BRUST, DAVID (NCLMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRUST
Suffix:
Gender:M
Credentials:NCLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 DIMOND DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1304
Mailing Address - Country:US
Mailing Address - Phone:907-727-3399
Mailing Address - Fax:
Practice Address - Street 1:1610 DIMOND DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1304
Practice Address - Country:US
Practice Address - Phone:907-727-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-10
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225700000X225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist