=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861406514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL JOSEPH BRUSE P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 07/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 S STATE ST
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84654-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-529-2234
-----------------------------------------------------
Fax | 435-529-2236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 S STATE ST
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84654-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-529-2234
-----------------------------------------------------
Fax | 435-529-2236
-----------------------------------------------------
=====================================================
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 | 121523-2401
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------