Provider Demographics
NPI:1912676032
Name:BRUHL, ANDREW (CPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BRUHL
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-1634
Mailing Address - Country:US
Mailing Address - Phone:228-282-4849
Mailing Address - Fax:
Practice Address - Street 1:2523 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-1634
Practice Address - Country:US
Practice Address - Phone:228-282-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12105994902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer