Individual
MR. KEVIN JON BRUSSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2629 N 7TH ST, SHEBOYGAN, WI 53083-4932
(920) 451-5000
Mailing address
1099 CREEKS CROSS CT, KOHLER, WI 53044-1347
(920) 208-8670
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9888-024
WI
2251S0007X
Sports Physical Therapist
9888
WI
2251X0800X
Orthopedic Physical Therapist
9888
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40471600
—
WI
Enumeration date
04/13/2007
Last updated
12/08/2021
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