Provider Demographics
NPI:1962776930
Name:BRUZZESE, ASHLEY VICTORIA (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:VICTORIA
Last Name:BRUZZESE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:V
Other - Last Name:DEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 COOPER FOSTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1201
Mailing Address - Country:US
Mailing Address - Phone:440-315-7358
Mailing Address - Fax:
Practice Address - Street 1:1317 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1201
Practice Address - Country:US
Practice Address - Phone:440-315-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1245400852OtherBILLING/COMPANY NPI