MEDICARE: AMY LEIGH BRUN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT20230	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083751994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEIGH BRUN MPT

Provider Business Mailing Address
First Line	:	3801 S. KENWOOD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1523
Country	:	US
Telephone Number	:	561-702-2377
Fax Number	:	813-253-3113

Provider Business Practice Location Address
First Line	:	3801 S. KENWOOD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1523
Country	:	US
Telephone Number	:	561-702-2377
Fax Number	:	813-253-3113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/10/2011

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