Organization
BRUTICO FOOT AND ANKLE SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA BALSLEY (PRACTICE ADMINISTRATOR)
(215) 259-5080
Entity
Organization
Contact information
Practice address
255 EAST GROVE STREET, CLARKS SUMMIT, PA 18411
(570) 936-2960
(570) 936-2961
Mailing address
255 EAST GROVE STREET, CLARKS SUMMIT, PA 18411
(570) 936-2960
(570) 936-2961
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103894240
—
PA
Enumeration date
07/29/2022
Last updated
05/14/2024
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