Provider Demographics
NPI:1396938817
Name:WOLLMAN, BRUCE S (PT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:S
Last Name:WOLLMAN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:9622 BUSTLETON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3100
Mailing Address - Country:US
Mailing Address - Phone:215-677-8258
Mailing Address - Fax:215-673-4966
Practice Address - Street 1:9622 BUSTLETON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-3100
Practice Address - Country:US
Practice Address - Phone:215-677-8258
Practice Address - Fax:215-673-4966
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2010-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011151-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist