Provider Demographics
NPI:1912942194
Name:BRUTON, JAMES E JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:BRUTON
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:636 W PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4516
Mailing Address - Country:US
Mailing Address - Phone:417-844-3125
Mailing Address - Fax:417-269-5508
Practice Address - Street 1:3545 S NATIONAL AVE
Practice Address - Street 2:MEYER CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-269-5530
Practice Address - Fax:417-260-5508
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1113332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer