Provider Demographics
NPI:1972826014
Name:BRUCE, PATRICIA ELLEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EVANS DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6221
Mailing Address - Country:US
Mailing Address - Phone:386-503-4899
Mailing Address - Fax:
Practice Address - Street 1:15 CYPRESS BRANCH WAY
Practice Address - Street 2:SUITE 207E
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8413
Practice Address - Country:US
Practice Address - Phone:386-503-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28511172M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No174400000XOther Service ProvidersSpecialist