Provider Demographics
NPI:1649826744
Name:BRUDER, LYNN GILLIES (DPT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:GILLIES
Last Name:BRUDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-578-4538
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:90 CROSSROAD HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3703
Practice Address - Country:US
Practice Address - Phone:828-492-0592
Practice Address - Fax:828-492-0593
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist