Provider Demographics
NPI:1851369268
Name:BRUESEWITZ, MONICA RODRIGUEZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:RODRIGUEZ
Last Name:BRUESEWITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:NANCY
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10318 BRONZE WOOD CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521
Mailing Address - Country:US
Mailing Address - Phone:775-851-4039
Mailing Address - Fax:
Practice Address - Street 1:10318 BRONZE WOOD CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5154
Practice Address - Country:US
Practice Address - Phone:775-240-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0794225100000X
MN5158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5158OtherPHYSICAL THERAPY LICENSE