Provider Demographics
NPI:1518939099
Name:BRUNING, PAUL M (DHA ATC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BRUNING
Suffix:
Gender:M
Credentials:DHA ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:710 COMMERCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4919
Mailing Address - Country:US
Mailing Address - Phone:651-968-5986
Mailing Address - Fax:651-968-5899
Practice Address - Street 1:710 COMMERCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4919
Practice Address - Country:US
Practice Address - Phone:651-968-5986
Practice Address - Fax:651-968-5899
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN14072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer