Provider Demographics
NPI:1285808212
Name:BRUCE, WENDY DAWN (PT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:DAWN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3000
Mailing Address - Country:US
Mailing Address - Phone:574-233-8812
Mailing Address - Fax:574-233-8873
Practice Address - Street 1:4630 CRAWFORD CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3545
Practice Address - Country:US
Practice Address - Phone:574-233-8812
Practice Address - Fax:574-233-8873
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007087A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics