Provider Demographics
NPI:1871667501
Name:BRUNI, ANTONIO (PT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BRUNI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1110
Mailing Address - Country:US
Mailing Address - Phone:716-282-2888
Mailing Address - Fax:716-285-1281
Practice Address - Street 1:924 MAIN ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1110
Practice Address - Country:US
Practice Address - Phone:716-282-2888
Practice Address - Fax:716-285-1281
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0261521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02626786Medicaid
NY000593030003OtherBCBS
NY9395584OtherINDEPENDENT HEALTH
NYRA2452Medicare PIN