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General NPI Number Information
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NPI Number | 1922003359
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Entity Type | Individual
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Provider Name | BRUCE DALE PAULS PT,MS,ATC
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 616 W PLATT ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2118
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Country | US
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Telephone | 563-652-4364
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Fax | 563-652-6818
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Provider Business Mailing Address
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Address Line | 616 W PLATT ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2118
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Country | US
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Telephone | 563-652-4364
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Fax | 563-652-6818
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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 | 0769
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 00082
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License Number State | IA
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