Provider Demographics
NPI:1760507776
Name:SITLER, BRUCE LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LEE
Last Name:SITLER
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 1:259 MEAD RUN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JEWETT
Mailing Address - State:PA
Mailing Address - Zip Code:16740-2037
Mailing Address - Country:US
Mailing Address - Phone:814-778-5159
Mailing Address - Fax:
Practice Address - Street 1:BRADFORD ECUMENICAL HOME
Practice Address - Street 2:100 ST. FRANCIS DRIVE
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-368-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000505E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist