Provider Demographics
NPI:1871231381
Name:BRUCE, RUSSELL EUGENE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:EUGENE
Last Name:BRUCE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1799
Mailing Address - Country:US
Mailing Address - Phone:413-263-3400
Mailing Address - Fax:
Practice Address - Street 1:425 PIPER RD
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1799
Practice Address - Country:US
Practice Address - Phone:413-263-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23022081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2302OtherMA BOARD OF ALLIED HEALTH