Healthcare Provider Details

I. General information

NPI: 1629859145
Provider Name (Legal Business Name): ERICA BRUCE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 NW BURNSIDE RD
GRESHAM OR
97030-3836
US

IV. Provider business mailing address

5300 PARKVIEW DR APT 1027
LAKE OSWEGO OR
97035-8724
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64965
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: