Provider Demographics
NPI:1861956344
Name:BRUCHMAN, GARY (PTA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BRUCHMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24726 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9704
Mailing Address - Country:US
Mailing Address - Phone:262-843-8333
Mailing Address - Fax:262-843-2948
Practice Address - Street 1:24726 75TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9704
Practice Address - Country:US
Practice Address - Phone:262-843-8333
Practice Address - Fax:262-843-2948
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant