Provider Demographics
NPI:1861406514
Name:BRUSE, DANIEL JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BRUSE
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 1:190 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:UT
Mailing Address - Zip Code:84654-1345
Mailing Address - Country:US
Mailing Address - Phone:435-529-2234
Mailing Address - Fax:435-529-2236
Practice Address - Street 1:190 S STATE ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1345
Practice Address - Country:US
Practice Address - Phone:435-529-2234
Practice Address - Fax:435-529-2236
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121523-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT49749OtherPEHP
UT870384752005Medicaid
UT107008388101OtherSELECT HEALTH CARE
UTD2716Medicaid
UT005519702Medicare PIN