Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1491 | NE |
NPI | 1003183575 |
---|---|
Provider Name | Mrs. Susan Lynn Bruggeman |
First Address | Omaha, NE 68116-4126 |
Second Address | Gretna, NE 68028-7970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |