Provider Demographics
NPI:1902137318
Name:BRUTON, MINDY (LMT)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2975
Mailing Address - Country:US
Mailing Address - Phone:419-354-2464
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:SUITE 218
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2975
Practice Address - Country:US
Practice Address - Phone:419-354-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017844 A-B225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist