Kevin James Bullock, PTA
Physical Therapy Assistant in Desloge, MO. Individual provider (NPI-1).
NPI number1003572082
StatusActive
Last updated in NPPESNov 13, 2021
Details
- NPI
- 1003572082
- Entity type
- Individual (NPI-1)
- Name
- Kevin James Bullock
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 13, 2021
- Certification date
- Nov 13, 2021
- Last updated
- Nov 13, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | – | – | Yes |
Practice location
801 Brim StDesloge, MO 63601-3441
Phone 573-431-0223
Mailing address
801 Brim StDesloge, MO 63601-3441
Phone 573-431-0223
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All 15 Physical Therapy Assistant providers in Desloge · All 104 providers in Desloge
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