NPI 1144617036

Carl Bruckner, LMT

Practitioner Massage Therapist Roswell, GA

Practice location

Address: 109 Thrush Dr, Roswell, GA 30075-1141
Phone: (408) 731-0592

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence MT 010291 (GA)

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Registry record

NPI: 1144617036
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Apr 2015
Record last updated: 19 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.