Provider Demographics
NPI:1215158522
Name:DEBRUIN, LAURA J (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:DEBRUIN
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 1:37 ROUTE 236
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904
Mailing Address - Country:UM
Mailing Address - Phone:207-439-2675
Mailing Address - Fax:207-439-4965
Practice Address - Street 1:1150 W COLUMBUS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2502
Practice Address - Country:US
Practice Address - Phone:413-241-8900
Practice Address - Fax:413-241-8901
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT00756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist