Active NPI
Perry D Bruce, PT
- Physical Therapist
- Lakeland, FL
National Provider Identifier
1104197367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT13671
- Practice address
- 3110 Oakbridge Blvd E
Lakeland, FL 33803-5987 - Phone
- (863) 648-4800
- NPI assigned
- Jan 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT13671 | FL | Primary |
Addresses
Primary practice location
3110 Oakbridge Blvd E
Lakeland, FL 33803-5987
Mailing address
5928 Coveview Dr W
Lakeland, FL 33813-4815
Phone (863) 937-4770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT13671 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326931200000",
"number": "1104197367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5928 COVEVIEW DR W",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338134815",
"telephone_number": "863-937-4770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3110 OAKBRIDGE BLVD E",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338035987",
"telephone_number": "863-648-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCE",
"first_name": "PERRY",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-19",
"last_updated": "2012-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT13671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.