| Doctor Name: | BRIAN K BRUNCKHORST |
| NPI Number: | 1235234972 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 40QA01149200 |
| Business Practice Address: | 1 W Ridgewood Ave Suite 104 Paramus, NJ - 076522359 |
| Business Phone Number: | 2016521415 |
| Business Fax Number: | 2016520391 |
| Mailing Address: | 676 Martense Ave, TEANECK |
| State: | NJ |
| Postal Code: | 076661838 |
| Phone Number: | 2014568534 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA01149200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |