Provider Demographics
NPI:1548866742
Name:BRUCH, KATHRYN C (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
Last Name:BRUCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MANSEAU ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1575
Mailing Address - Country:US
Mailing Address - Phone:215-913-4436
Mailing Address - Fax:
Practice Address - Street 1:1191 S BROWNELL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7415
Practice Address - Country:US
Practice Address - Phone:315-491-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT40.01341732251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports