Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 005405-1 | NY |
NPI | 1013198522 |
---|---|
Provider Name | Monica Bruce |
First Address | Brooklyn, NY 11226-4221 |
Second Address | Brooklyn, NY 11226-4221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 27/11/2007 |