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Individual

MR. BRUCE DALE PAULS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT,MS,ATC

Contact information

Practice address
616 W PLATT ST, MAQUOKETA, IA 52060-2118
(563) 652-4364
(563) 652-6818
Mailing address
616 W PLATT ST, MAQUOKETA, IA 52060-2118
(563) 652-4364
(563) 652-6818

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0769
IA
2255A2300X
Athletic Trainer
00082
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0199000
IA
Enumeration date
06/13/2005
Last updated
10/11/2007
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