Provider Demographics
NPI:1679602999
Name:AMUNDSON, BRUCE TORFIN (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:TORFIN
Last Name:AMUNDSON
Suffix:
Gender:M
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:ABERCROMBIE
Mailing Address - State:ND
Mailing Address - Zip Code:58001-0105
Mailing Address - Country:US
Mailing Address - Phone:701-553-8606
Mailing Address - Fax:
Practice Address - Street 1:332 2D AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58074
Practice Address - Country:US
Practice Address - Phone:701-642-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist