# BRUTICO FOOT AND ANKLE SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154057362
- **Authorized official:** TARA BALSLEY (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (215) 259-5080

## Contact information

- **Practice address:** 255 EAST GROVE STREET, CLARKS SUMMIT, PA 18411
- **Practice address phone:** (570) 936-2960
- **Practice address fax:** (570) 936-2961
- **Mailing address:** 255 EAST GROVE STREET, CLARKS SUMMIT, PA 18411
- **Mailing address phone:** (570) 936-2960
- **Mailing address fax:** (570) 936-2961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 07/29/2022
- **Last updated:** 05/14/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103894240 | — | PA |