Provider Demographics
NPI:1760454599
Name:BRUNO, KENNETH R II (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:BRUNO
Suffix:II
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 1:396 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2024
Mailing Address - Country:US
Mailing Address - Phone:203-762-5623
Mailing Address - Fax:203-762-9344
Practice Address - Street 1:396 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2024
Practice Address - Country:US
Practice Address - Phone:203-762-5623
Practice Address - Fax:203-762-9344
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0800006989OtherBLUE CROSS BLUE SHIEL
NYQ26X4OtherEMPIRE BLUE CROSS