Provider Demographics
NPI:1528111358
Name:HA, BRUCE CHI TRUNG (DPT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:CHI TRUNG
Last Name:HA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:TRUNG
Other - Middle Name:CHI
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 NORTH OLIVE AVENUE
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-943-0229
Mailing Address - Fax:
Practice Address - Street 1:438 W LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1216
Practice Address - Country:US
Practice Address - Phone:626-570-6587
Practice Address - Fax:626-457-3257
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist