Provider Demographics
NPI:1902220163
Name:BRUCE, BOBBY WAYNE JR (LMT / MMP)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:WAYNE
Last Name:BRUCE
Suffix:JR
Gender:M
Credentials:LMT / MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4222
Mailing Address - Country:US
Mailing Address - Phone:256-467-4811
Mailing Address - Fax:
Practice Address - Street 1:244 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4222
Practice Address - Country:US
Practice Address - Phone:256-467-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist