Individual
BRIAN LARUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
100 VALLEY CENTER RD, WILMINGTON, DE 19808-2950
(302) 994-1200
(302) 994-1233
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10002000
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000040229
AMERIHEALTH/IBC
PA
05
—
1000038248
—
DE
01
—
105165
PA BCBS
PA
01
—
5070-0053
CAREFIRST
—
01
—
88760507
CAREFIRST
—
01
—
J10002000
DE LICENSE
DE
Enumeration date
01/12/2007
Last updated
03/04/2013
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