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:
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Health care specialties

SpecialtyCodeLicense #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 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790260123 NPPES
Connecticut Other 11878 PT LICENSE

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