Brunckhorst, Charles
Brunckhorst, Charles is an individual health care provider with primary practice located at 1931 Black Rock Tpke , Fairfield CT 06825-3506. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Brunckhorst, Charles can be contacted via phone (203) 384-8681.Contact Information
Primary practice address
1931 Black Rock Tpke
Fairfield CT 06825-3506
Phone: (203) 384-8681
Fax: (203) 384-0722
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 11878 | Connecticut |
Profile Details
| NPI number | 1790260123 |
|---|---|
| LBN Legal business name | Brunckhorst, Charles |
| Credentials | PT, DPT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 2nd, 2018 |
| Last updated | Oct 2nd, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790260123 | NPPES |
| Connecticut | Other | 11878 | PT LICENSE |
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