Kevin James Bullock, PTA
Individual provider Active NPI Physical Therapy Assistant · Desloge, MO
NPI 1003572082 · NPPES record last updated Nov 13, 2021
Key facts
- NPI
- 1003572082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- Practice address
- 801 Brim St
Desloge, MO 63601-3441 - Phone
- (573) 431-0223
- NPI assigned
- Nov 13, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | Yes |
Addresses
Primary practice location
801 Brim St
Desloge, MO 63601-3441
Mailing address
801 Brim St
Desloge, MO 63601-3441
Phone (573) 431-0223
Other providers in Desloge, MO
- Gay Ampo Bigcas
- Krystal J. Braun
- Randi Jo Brewer
- Jodi L. Brown
- Kari Buerck
- Kelley Suzanne Bumgardaner
- Alison Mary Burd
- Burd'S Eye View, PC
- Cynthia Frances Castro
- Clay Medical Supplies LLC
All providers in Desloge, MO · Physical Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.