Provider Demographics
NPI:1144476383
Name:BRUINSMA, HOLLY MICHELLE (RKT, EP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MICHELLE
Last Name:BRUINSMA
Suffix:
Gender:F
Credentials:RKT, EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 SAFFRON PLUM LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-765-6755
Mailing Address - Fax:
Practice Address - Street 1:5165 ADANSON STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-7600
Practice Address - Fax:407-303-7666
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1482226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist