Provider Demographics
NPI:1902399272
Name:BEHRENS, BRUCE E
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 NW CASABLANCA LN UNIT 316
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-0029
Mailing Address - Country:US
Mailing Address - Phone:712-210-0831
Mailing Address - Fax:
Practice Address - Street 1:3410 NW CASABLANCA LN UNIT 316
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-0029
Practice Address - Country:US
Practice Address - Phone:712-210-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225100000X
IA092573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist