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General NPI Number Information
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NPI Number | 1972826014
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Entity Type | Individual
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Provider Name | PATRICIA ELLEN BRUCE LMT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 15 CYPRESS BRANCH WAY SUITE 207E
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City | PALM COAST
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State | FL
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Zip | 32164-8413
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Country | US
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Telephone | 386-503-4899
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Fax |
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Provider Business Mailing Address
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Address Line | 5 EVANS DR
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City | PALM COAST
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State | FL
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Zip | 32164-6221
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Country | US
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Telephone | 386-503-4899
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA28511
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA28511
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License Number State | FL
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