Provider Demographics
NPI:1356418834
Name:BRUTICO, ARIANA (MS PT)
Entity type:Individual
Prefix:MRS
First Name:ARIANA
Middle Name:
Last Name:BRUTICO
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E. GROVE ST.
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411
Mailing Address - Country:US
Mailing Address - Phone:570-586-1188
Mailing Address - Fax:570-585-7323
Practice Address - Street 1:115 E. GROVE ST.
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-586-1188
Practice Address - Fax:570-585-7323
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009300225100000X
PAPT019103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist