Provider Demographics
NPI:1477862175
Name:BRUCKMAN, SERENA CHEUNG (PT, DPT, NCS)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:CHEUNG
Last Name:BRUCKMAN
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PORTAGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2213
Mailing Address - Country:US
Mailing Address - Phone:650-935-4711
Mailing Address - Fax:
Practice Address - Street 1:425 PORTAGE AVE STE A
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2213
Practice Address - Country:US
Practice Address - Phone:650-935-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT20815225100000X
NY038793-1225100000X
CT11870225100000X
CAPT298314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist