Provider Demographics
NPI:1952510364
Name:FUGGITI, BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:FUGGITI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W BERTEAU AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-6243
Mailing Address - Country:US
Mailing Address - Phone:773-282-5485
Mailing Address - Fax:
Practice Address - Street 1:8337 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3129
Practice Address - Country:US
Practice Address - Phone:708-583-9500
Practice Address - Fax:708-583-9501
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.04098283X00000X
IL07000498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No283X00000XHospitalsRehabilitation Hospital