Provider Demographics
NPI:1689639288
Name:BRUCE, JENNIFER D (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:BRUCE
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 1:7799 OAK HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-7826
Mailing Address - Country:US
Mailing Address - Phone:704-252-0317
Mailing Address - Fax:
Practice Address - Street 1:9800 KINCEY AVE
Practice Address - Street 2:STE 180
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8415
Practice Address - Country:US
Practice Address - Phone:704-948-2701
Practice Address - Fax:704-948-2859
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
346606Medicare ID - Type Unspecified
2508531Medicare PIN