Provider Demographics
NPI:1023229853
Name:WILLS, BRUCE RANNE (MPT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:RANNE
Last Name:WILLS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 WHISPEROAK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8135
Mailing Address - Country:US
Mailing Address - Phone:321-676-2055
Mailing Address - Fax:321-676-9928
Practice Address - Street 1:650 S COURTENAY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4977
Practice Address - Country:US
Practice Address - Phone:321-394-2660
Practice Address - Fax:321-394-2669
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5799174400000X
FLPT5799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3810ZMedicare ID - Type Unspecified