Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT009675 | GA |
N | 225100000X | Physical Therapist | PT3118 | AR |
NPI | 1003051442 |
---|---|
Provider Name | Mrs. Joel Adrianna Bruno |
First Address | Atlanta, GA 30316-1526 |
Second Address | Atlanta, GA 30316-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 18/05/2015 |