Provider Demographics
NPI:1356175152
Name:BRUCE, CALVIN LEE JR
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:LEE
Last Name:BRUCE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5661 JESSUP MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4188
Mailing Address - Country:US
Mailing Address - Phone:434-865-0215
Mailing Address - Fax:
Practice Address - Street 1:2103 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2235
Practice Address - Country:US
Practice Address - Phone:434-865-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019010556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist