Individual
MR. MICHAEL MATTHEW BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
120 PLAZA DR, SUITE E, VESTAL, NY 13850-3640
(607) 797-5414
(607) 797-6537
Mailing address
902 JEANETTE RD, ENDICOTT, NY 13760-3828
(607) 785-0907
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
011764-1
NY
2251S0007X
Sports Physical Therapist
011764-1
NY
2251X0800X
Orthopedic Physical Therapist
Primary
011764-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089686
GHI-HMO
NY
05
—
02252115
—
NY
01
—
10055823
CDPHP
NY
01
—
3962334
AETNA-HMO
NY
01
—
438126
MVP
NY
01
—
4552539
AETNA-EPO
NY
01
—
64-01196
UHC-PPO
NY
01
—
6697062
GHI-PPO
NY
01
—
9976077625901
GEICO
NY
01
—
G0186259040
MONROE
NY
Enumeration date
11/12/2006
Last updated
09/11/2025
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