Healthcare Provider Details

I. General information

NPI: 1669956629
Provider Name (Legal Business Name): DEBRUIN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BRIMFIELD WAY
WESTFIELD MA
01085-0108
US

IV. Provider business mailing address

18 BRIMFIELD WAY
WESTFIELD MA
01085
US

V. Phone/Fax

Practice location:
  • Phone: 413-519-9531
  • Fax:
Mailing address:
  • Phone: 413-519-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA J DEBRUIN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 413-519-9531