Provider Demographics
NPI:1689487241
Name:BRUNO, NICOLE ANN (PTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:BRUNO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SULLIVAN FARM
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-4500
Mailing Address - Country:US
Mailing Address - Phone:203-300-2794
Mailing Address - Fax:
Practice Address - Street 1:6 LOGGING TRAIL LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1345
Practice Address - Country:US
Practice Address - Phone:203-744-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
CT001001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant