MEDICARE: MR. JEFF BRUINS

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	PT24941	CA

General Provider Information

NPI Number	:	1255490090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF BRUINS

Provider Business Mailing Address
First Line	:	1600 EUREKA RD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2795 MALLARD WAY
Second Line	:
City	:	LINCOLN
State	:	CA
Zip	:	95648-2465
Country	:	US
Telephone Number	:	916-521-0801
Fax Number	:

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JEFF BRUINS ” Practice Location

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