Provider Demographics
NPI:1689124398
Name:BRUZGA, PHILIP (DPT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BRUZGA
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 1:1423 STAPLER PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2529
Mailing Address - Country:US
Mailing Address - Phone:717-798-6785
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:750 PRIDES XING STE 112
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6107
Practice Address - Country:US
Practice Address - Phone:302-864-2222
Practice Address - Fax:302-907-4028
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist