Basic Information
| Provider Information | |||||||||
| NPI: | 1023229853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | RANNE | ||||||||
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| Credential: | M.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 972 WHISPEROAK DR | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329018135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216762055 | ||||||||
| FaxNumber: | 3216769928 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 S COURTENAY PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329524977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213942660 | ||||||||
| FaxNumber: | 3213942669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT 5799 | FL | N | Other Service Providers | Specialist | 225100000X | PT5799 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.