Provider Demographics
NPI:1801042908
Name:BRUNO-CARRON, ANGELA TINA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:TINA
Last Name:BRUNO-CARRON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:TINA
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 N CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2152
Mailing Address - Country:US
Mailing Address - Phone:516-410-8498
Mailing Address - Fax:516-825-3537
Practice Address - Street 1:259 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3243
Practice Address - Country:US
Practice Address - Phone:516-410-8498
Practice Address - Fax:516-825-3537
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011557-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics