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General NPI Number Information
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NPI Number | 1568883445
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Entity Type | Individual
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Provider Name | JEFFREY BRUNNER PT
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Gender | Male
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 835 S VAN BUREN ST
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City | GREEN BAY
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State | WI
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Zip | 54301-3526
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Country | US
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Telephone | 920-433-8151
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Fax |
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Provider Business Mailing Address
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Address Line | W9350 FRIENDSHIP RD
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City | SHAWANO
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State | WI
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Zip | 54166-6319
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Country | US
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Telephone | 715-526-2887
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5274-24
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License Number State | WI
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