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NPI Code Detail

MEDICARE: DOMINIC BRUZZESE

MEDICARE:   DOMINIC  BRUZZESE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A-0371OTHERNVLICENSE #

General Provider Information

NPI Number : 1578673224
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIC BRUZZESE
Provider Business Mailing Address
First Line : 6615 W TROPICANA AVE
Second Line : STE 101
City : LAS VEGAS
State : NV
Zip : 89103-4782
Country : US
Telephone Number : 702-362-6282
Fax Number :
Provider Business Practice Location Address
First Line : 4955 S DURANGO DR
Second Line : STE 100
City : LAS VEGAS
State : NV
Zip : 89113-0152
Country : US
Telephone Number : 702-254-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Directions to “ DOMINIC BRUZZESE ” Practice Location

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