Basic Information
| Provider Information | |||||||||
| NPI: | 1376519603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUBECK | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 COUNTRY CLUB RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974016044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416835139 | ||||||||
| FaxNumber: | 5416835783 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 COUNTRY CLUB RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974016044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416835139 | ||||||||
| FaxNumber: | 5416835783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1124 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.