Provider Demographics
NPI:1710967880
Name:BRUCE, MARY E (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-871-0789
Mailing Address - Fax:508-366-9938
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-871-0789
Practice Address - Fax:508-366-9938
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y67702OtherBLUE CARE ELECT
42391OtherFALLON COMMUNITY HEALTH P
AA4052OtherHARVARD PILGRIM HEALTHCAR
Y67702OtherBLUE SHIELD INDEMNITY
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
2779432OtherCIGNA HEALTH PLAN
35481155OtherCIGNA HEALTHSOURCE
Y67702OtherBLUE SHIELD HMO BLUE
785947OtherMVP HEALTH CARE
2779432001OtherCIGNA PAL ID REFERRAL #
650017417OtherRAILROAD MEDICARE
MA0318761Medicaid
042472266OtherONE HEALTH PLAN
7695593OtherAETNA US HEALTHCARE
2779432OtherCIGNA HEALTH PLAN
35481155OtherCIGNA HEALTHSOURCE