Gino John Brunello, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT16371 Issued in CA

Practice address

2530 Professional Pkwy
Santa Maria, CA 93455-1602

Phone

(805) 928-4465

Fax

(805) 928-7935

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stephenville Sports Rehab & Physical Therapy, LLC

  • Physical Medicine & Rehabilitation Physician
  • Weatherford, TX
  • NPI 1932291697

  Physical Therapist

  Medicare reassignment NPD
• Coastal Communities Physician Network, Inc.

  • Health Maintenance Organization
  • San Luis Obispo, CA
  • NPI 1275735011
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063579910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 PROFESSIONAL PKWY",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934551602",
            "telephone_number": "805-928-4465",
            "fax_number": "805-928-7935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 PROFESSIONAL PKWY",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934551602",
            "telephone_number": "805-928-4465",
            "fax_number": "805-928-7935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNELLO",
        "first_name": "GINO",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT16371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0163710",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "OPT163710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Harbin Brown, MPA
• Makeda-I Brown, LVN
• Ramona J. Brown, RN
• Bruce a Ourieff MD Inc.
• Bruce F. Mize, M.D., Inc.
• Theresa Brunello
• Isabel Bryant
• BTC Heg, Inc. (Balance Treatment Santa Maria)
• Richelle Bucayu
• Ashley Buchanan

• Physical Therapist in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.