Healthcare Provider Details

I. General information

NPI: 1568610103
Provider Name (Legal Business Name): BRYAN NICHOLAS TRUMM M.D., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DELHI ST STE 4200
DUBUQUE IA
52001
US

IV. Provider business mailing address

1500 DELHI ST STE 4200
DUBUQUE IA
52001-6391
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-5999
  • Fax: 563-557-5990
Mailing address:
  • Phone: 563-557-5999
  • Fax: 563-557-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004190
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-45200
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: