Healthcare Provider Details

I. General information

NPI: 1114832664
Provider Name (Legal Business Name): TI'ANNA BRUCE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 W DEER VALLEY RD STE 210
PEORIA AZ
85382-2120
US

IV. Provider business mailing address

15431 N 67TH AVE APT 3056
GLENDALE AZ
85306-3777
US

V. Phone/Fax

Practice location:
  • Phone: 623-208-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034924
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: