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BRUCE CHESTER SOUTHWELL

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
7617 SYLVANIA AVE, SYLVANIA, OH 43560-9517
(419) 843-1402
(419) 843-1407
Mailing address
7617 SYLVANIA AVE, SYLVANIA, OH 43560-9517
(419) 843-1402
(419) 843-1407

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT6492
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20372143500
BWC
OH
Enumeration date
06/15/2006
Last updated
07/08/2007
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