Provider Demographics
NPI:1285738781
Name:BRUNEAU, RANDY WADE (PT MS)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:WADE
Last Name:BRUNEAU
Suffix:
Gender:M
Credentials:PT MS
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Mailing Address - Street 1:23D CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4601
Mailing Address - Country:US
Mailing Address - Phone:781-272-5151
Mailing Address - Fax:781-272-9992
Practice Address - Street 1:23D CAMBRIDGE ST.
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4601
Practice Address - Country:US
Practice Address - Phone:781-272-5151
Practice Address - Fax:781-272-9992
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-02-22
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Provider Licenses
StateLicense IDTaxonomies
MA13091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68841Medicare ID - Type UnspecifiedPHYSICAL THERAPIST