Healthcare Provider Details

I. General information

NPI: 1972542017
Provider Name (Legal Business Name): CARL FRANCIS BRUNO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

771 PILOT HOUSE DRIVE SUITE A
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-6300
  • Fax: 757-539-0704
Mailing address:
  • Phone: 757-873-2302
  • Fax: 757-873-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305004860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: