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General NPI Number Information
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NPI Number | 1548866742
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Entity Type | Individual
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Provider Name | KATHRYN C BRUCH DPT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 1191 S BROWNELL RD
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City | WILLISTON
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State | VT
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Zip | 05495-7415
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Country | US
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Telephone | 315-491-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MANSEAU ST UNIT 206
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City | WINOOSKI
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State | VT
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Zip | 05404-1575
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Country | US
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Telephone | 215-913-4436
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 40.0134173
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License Number State | VT
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