Provider Demographics
NPI:1386932788
Name:BRUNER-WILSON, CHRISTINE M (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BRUNER-WILSON
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CIRCLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2749
Mailing Address - Country:US
Mailing Address - Phone:317-851-8889
Mailing Address - Fax:
Practice Address - Street 1:203 CIRCLEVIEW DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2749
Practice Address - Country:US
Practice Address - Phone:317-851-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007194A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist