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General NPI Number Information
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NPI Number | 1487799961
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Entity Type | Individual
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Provider Name | GREGG L BRUECK ATC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF VERMONT 140 PATRICK GYM 97 SPEAR STREET
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City | BURLINGTON
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State | VT
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Zip | 05405-0001
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Country | US
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Telephone | 802-656-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 86 TYLER BRIDGE RD
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City | HINESBURG
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State | VT
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Zip | 05461-9105
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Country | US
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Telephone | 802-482-6032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 104-0000090
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License Number State | VT
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