Provider Demographics
NPI:1780220269
Name:BRUCE, JACOB FRANCIS (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:FRANCIS
Last Name:BRUCE
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 1:515 N STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1572
Mailing Address - Country:US
Mailing Address - Phone:509-766-4277
Mailing Address - Fax:509-766-4280
Practice Address - Street 1:515 N STRATFORD RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1572
Practice Address - Country:US
Practice Address - Phone:509-766-4277
Practice Address - Fax:509-766-4280
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60872539208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation