Individual
CARL BRUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
109 THRUSH DR, ROSWELL, GA 30075-1141
(408) 731-0592
Mailing address
109 THRUSH DR, ROSWELL, GA 30075-1141
(408) 731-0592
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT 010291
GA
Other
Enumeration date
04/19/2015
Last updated
04/19/2015
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