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General NPI Number Information
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NPI Number | 1992929582
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Entity Type | Individual
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Provider Name | KEVIN JON BRUSSE P.T.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 2629 N 7TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53083-4932
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Country | US
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Telephone | 920-451-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1099 CREEKS CROSS CT
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City | KOHLER
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State | WI
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Zip | 53044-1347
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Country | US
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Telephone | 920-208-8670
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 9888
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 9888
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9888-024
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License Number State | WI
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