Provider Demographics
NPI:1790674901
Name:BRUNO, ETHAN (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NE 7TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4515
Mailing Address - Country:US
Mailing Address - Phone:541-728-0974
Mailing Address - Fax:541-728-0159
Practice Address - Street 1:915 NE 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4515
Practice Address - Country:US
Practice Address - Phone:541-728-0974
Practice Address - Fax:541-728-0159
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist