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Individual
SUSAN R. BRUNDAGE
Active
Individual
SUSAN R. BRUNDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, MPT, OCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 28782
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT287820
BLUE SHIELD
CA
01
—
218943
L & I WASHINGTON
WA
01
—
72157585392277A003
TRICARE
CA
05
—
PT0287820
—
CA
Enumeration date
01/20/2007
Last updated
01/18/2017
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