Individual provider Active NPI

Emily Bruce, DPT

  • Physical Therapist
  • Fort Wayne, IN
National Provider Identifier
1154943934
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05013751A Issued in IN
Practice address
10146 Maysville Rd
Fort Wayne, IN 46835-9589
Phone
(260) 702-3477
Fax
(260) 238-8077
NPI assigned
May 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05013751A IN Primary

Addresses

Primary practice location

10146 Maysville Rd
Fort Wayne, IN 46835-9589

Mailing address

1303 Pion Rd
Fort Wayne, IN 46845-9630
Phone (517) 306-0117

Other identifiers 1

IdentifierTypeStateIssuer
05013751AOtherININ LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200623002411 IN Practitioner - Physical Therapist in Private Practice 1759703671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, 1,992 clinicians

Practice addresses (Care Compare)

2607 16TH St
Suite 17
Bedford, IN 47421-3503
Phone (812) 578-7168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05013751AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Select Physical Therapy Holdings Inc CurrentSince Apr 16, 2024 Accepting new patients
Select Physical Therapy Holdings, Inc. Physical Therapist CurrentSince Apr 16, 2024 Accepting new patients
Select Physical Therapy Holdings, Inc. Current Accepting new patients
Protailored Physical Therapy LLC Physical Therapist CurrentSince Jun 17, 2020 Accepting new patients

Locations

2607 16th St
Ste 17
Bedford, IN 47421
Phone (515) 715-8081

12722 Tonkel Rd
Ste 102
Fort Wayne, IN 46845
Phone (260) 739-0300

10146 Maysville Rd
Fort Wayne, IN 46835
Phone (260) 702-3477

1520 N Hill Dr
Fort Wayne, IN 46825
Phone (260) 739-0300

12722 Tonkel Rd
Fort Wayne, IN 46845
Phone (260) 602-3472

3316 E Market St
Logansport, IN 46947
Phone (574) 601-3100

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1154943934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 PION RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468459630",
            "telephone_number": "517-306-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10146 MAYSVILLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468359589",
            "telephone_number": "260-702-3477",
            "fax_number": "260-238-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "EMILY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-14",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013751A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN LICENSE",
            "identifier": "05013751A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.