Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | 007755 | CT |
N | 225XE1200X | Ergonomics | 007755 | CT |
N | 2251S0007X | Physical Therapist - Sports | 007755 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 007755 | CT |
NPI | 1508877796 |
---|---|
Provider Name | Philip Joseph Brucella |
First Address | Middletown, CT 06457-4777 |
Second Address | Middletown, CT 06457-4777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |