Provider Demographics
NPI:1154943934
Name:BRUCE, EMILY (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PION RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9630
Mailing Address - Country:US
Mailing Address - Phone:517-306-0117
Mailing Address - Fax:
Practice Address - Street 1:10146 MAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9589
Practice Address - Country:US
Practice Address - Phone:260-702-3477
Practice Address - Fax:260-238-8077
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013751A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05013751AOtherIN LICENSE