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NPI Code Detail

MEDICARE: THERESA M. BRUN MPT

MEDICARE: THERESA M. 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
1174400000XSpecialistPT015824PA

General Provider Information

NPI Number : 1619978244
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA M. BRUN MPT
Provider Business Mailing Address
First Line : 420 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1568
Country : US
Telephone Number : 215-629-1270
Fax Number : 215-629-5531
Provider Business Practice Location Address
First Line : 9379 KREWSTOWN RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-3710
Country : US
Telephone Number : 215-676-6760
Fax Number : 215-676-3746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2005
Last Update Date : 11/06/2008

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