MEDICARE: DR. SERENA CHEUNG BRUCKMAN PT, DPT, NCS

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	PT20815	PA
2	225100000X	Physical Therapist	038793-1	NY
3	225100000X	Physical Therapist	11870	CT
4	225100000X	Physical Therapist	PT298314	CA

General Provider Information

NPI Number	:	1477862175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERENA CHEUNG BRUCKMAN PT, DPT, NCS

Provider Business Mailing Address
First Line	:	425 PORTAGE AVE STE A
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-2213
Country	:	US
Telephone Number	:	650-935-4711
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 PORTAGE AVE STE A
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-2213
Country	:	US
Telephone Number	:	650-935-4711
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	11/09/2020

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