Provider Demographics
NPI:1275654204
Name:BRUNGO, DAVID PAUL (PT, MBA, MS, AIB-CVR)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:BRUNGO
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Gender:M
Credentials:PT, MBA, MS, AIB-CVR
Other - Prefix:
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Mailing Address - Street 1:679 ORANGEBURG ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9038
Mailing Address - Country:US
Mailing Address - Phone:843-209-6375
Mailing Address - Fax:843-225-0348
Practice Address - Street 1:679 ORANGEBURG ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-209-6375
Practice Address - Fax:843-225-0348
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC4850225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist