Basic Information
| Provider Information | |||||||||
| NPI: | 1518911189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUMMEL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M ED PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8823 PRODUCTION LN | ||||||||
| Address2: | |||||||||
| City: | OOLTEWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373636511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162264011 | ||||||||
| FaxNumber: | 8165246115 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 E YOUNG AVE | ||||||||
| Address2: | SUITE E | ||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640931231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602624795 | ||||||||
| FaxNumber: | 6607470347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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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 | 01604 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | MA4370031 | 01 | MO | MEDICARE PTAN | OTHER | 19980080 | 01 | BCBS KC | OTHER |