Provider Demographics
NPI:1316632912
Name:BRUGGEMAN, JOHANNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:BRUGGEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-0026
Mailing Address - Country:US
Mailing Address - Phone:419-733-6385
Mailing Address - Fax:
Practice Address - Street 1:15 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1087
Practice Address - Country:US
Practice Address - Phone:419-733-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist