Stanley Todd Bruce Jr.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA002917 Issued in GA

Practice address

1451 Newton Dr
Tifton, GA 31794-3752

Phone

(229) 392-4426

NPI assigned

Jul 3, 2019

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 3, 2019.

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1114589686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 NEWTON DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 NEWTON DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943752",
            "telephone_number": "229-392-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "STANLEY",
        "middle_name": "TODD",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA002917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donovan Kaine Brown, M.D.
• Karen Elizabeth Brown, PAC
• Rebecca Angeles Denise Brown, NP-C
• Stacy Brown, OT
• Marsha S. Browning
• Charles E Bryan Jr., M.D.
• Joseph Vance Bryant, PT
• Angela Kennedy Bullard, FNP-BC
• Jill M Bullard, NP
• Cole Burgess, CRNA

• All providers in Tifton, GA
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.