Provider Demographics
NPI:1285942342
Name:BRUGGEMAN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRUGGEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 N AVE
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:NE
Mailing Address - Zip Code:68741-3067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 G ST
Practice Address - Street 2:
Practice Address - City:S SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3339
Practice Address - Country:US
Practice Address - Phone:402-494-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant