Individual
MRS. VICKI ELLEN BRUNGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1705 WARREN AVE STE 102, WILLIAMSPORT, PA 17701
(570) 320-7470
(570) 320-7471
Mailing address
831 MILL RD, WILLIAMSPORT, PA 17702-8122
(570) 419-6316
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE1001946
PA
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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