Healthcare Provider Details

I. General information

NPI: 1114098449
Provider Name (Legal Business Name): CANDICE BRUECK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MILITARY CUTOFF RD STE 110
WILMINGTON NC
28403-5719
US

IV. Provider business mailing address

1630 MILITARY CUTOFF RD STE 110
WILMINGTON NC
28403-5719
US

V. Phone/Fax

Practice location:
  • Phone: 910-798-2318
  • Fax:
Mailing address:
  • Phone: 910-798-2318
  • Fax: 910-798-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: