Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3369 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 3369 | AZ |
NPI | 1508917683 |
---|---|
Provider Name | Mitchell James Bruning |
First Address | Phoenix, AZ 85060-5858 |
Second Address | Phoenix, AZ 85018-7515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 18/01/2021 |