Provider Demographics
NPI:1063485852
Name:VANBRUGGEN, MICHAEL TODD (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:VANBRUGGEN
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:2130 S BRANNER AVE
Mailing Address - Street 2:CN BOX 72030
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2224
Mailing Address - Country:US
Mailing Address - Phone:865-471-3368
Mailing Address - Fax:865-471-3514
Practice Address - Street 1:2130 S BRANNER AVE
Practice Address - Street 2:CN BOX 72030
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2224
Practice Address - Country:US
Practice Address - Phone:865-471-3368
Practice Address - Fax:865-471-3514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN5612255A2300X
TXAT13452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer