Healthcare Provider Details

I. General information

NPI: 1437693439
Provider Name (Legal Business Name): SCOTT BRUNNING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N WACKER DR STE 1250
CHICAGO IL
60606-1911
US

IV. Provider business mailing address

310 N GIBBONS AVE
ARLINGTON HEIGHTS IL
60004-6453
US

V. Phone/Fax

Practice location:
  • Phone: 800-774-5962
  • Fax:
Mailing address:
  • Phone: 248-703-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: