Provider Demographics
NPI:1144643230
Name:LABRECQUE, BRUCE MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:MICHAEL
Last Name:LABRECQUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4166
Mailing Address - Country:US
Mailing Address - Phone:810-820-3931
Mailing Address - Fax:810-820-8762
Practice Address - Street 1:2129 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4166
Practice Address - Country:US
Practice Address - Phone:810-820-3931
Practice Address - Fax:810-820-8762
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist