Provider Demographics
NPI:1831986975
Name:BRUAL, CARLO CLEMENT
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:CLEMENT
Last Name:BRUAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9931 BEAUTYBERRY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-5607
Mailing Address - Country:US
Mailing Address - Phone:508-863-9737
Mailing Address - Fax:
Practice Address - Street 1:9931 BEAUTYBERRY
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-5607
Practice Address - Country:US
Practice Address - Phone:508-808-3771
Practice Address - Fax:508-863-9737
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18106225100000X
TX1189931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist