Provider Demographics
NPI:1659358612
Name:BRUSCHI, DENISE E (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:BRUSCHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-455-2630
Mailing Address - Fax:425-451-4390
Practice Address - Street 1:1188 106TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8614
Practice Address - Country:US
Practice Address - Phone:425-454-4864
Practice Address - Fax:425-646-3901
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335853Medicaid
WAG8857440Medicare PIN