=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326613670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOAH BRUECKNER PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2021
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6281 TRI RIDGE BLVD STE 20
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-8345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-218-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 676 AMBER TRL
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45244-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-218-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 008260
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT019282
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------