Provider Demographics
NPI:1568954451
Name:RUE, BRIAN CHARLES (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
Last Name:RUE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55930 BLUE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2369
Mailing Address - Country:US
Mailing Address - Phone:512-623-9772
Mailing Address - Fax:541-550-2919
Practice Address - Street 1:55930 BLUE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707-2369
Practice Address - Country:US
Practice Address - Phone:512-623-9772
Practice Address - Fax:541-550-2919
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63982225100000X
TX1308977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist