Basic Information
| Provider Information | |||||||||
| NPI: | 1710967880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUCE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088710789 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088710789 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4620 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y67702 | 01 | BLUE CARE ELECT | OTHER | 42391 | 01 | FALLON COMMUNITY HEALTH P | OTHER | AA4052 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | Y67702 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 2779432 | 01 | CIGNA HEALTH PLAN | OTHER | 35481155 | 01 | CIGNA HEALTHSOURCE | OTHER | Y67702 | 01 | BLUE SHIELD HMO BLUE | OTHER | 785947 | 01 | MVP HEALTH CARE | OTHER | 2779432001 | 01 | CIGNA PAL ID REFERRAL # | OTHER | 650017417 | 01 | RAILROAD MEDICARE | OTHER | 0318761 | 05 | MA | MEDICAID | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 7695593 | 01 | AETNA US HEALTHCARE | OTHER |