Provider Demographics
NPI:1932473642
Name:BRUSS, JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BRUSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WATERTOWER CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5801
Mailing Address - Country:US
Mailing Address - Phone:802-655-7575
Mailing Address - Fax:802-655-1115
Practice Address - Street 1:441 WATERTOWER CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5801
Practice Address - Country:US
Practice Address - Phone:802-655-7575
Practice Address - Fax:802-655-1115
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00731532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer