Active NPI
Kathy Bullock
- Physical Therapy Assistant
- South Ogden, UT
National Provider Identifier
1255626388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5597738-2402
- Practice address
- 5974 Fashion Point Dr
Ste 100
South Ogden, UT 84403-4699 - Phone
- (801) 479-9644
- Fax
- (801) 479-9639
- NPI assigned
- Jun 16, 2011
- Last updated
- Jun 16, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5597738-2402 | UT | Primary |
Addresses
Primary practice location
5974 Fashion Point Dr
Ste 100
South Ogden, UT 84403-4699
Mailing address
1892 W 1590 S
Woods Cross, UT 84087-2474
Phone (801) 913-5879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5597738-2402 | UT | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Wellness Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- South Ogden, UT
- NPI 1174858823
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308182400000",
"number": "1255626388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1892 W 1590 S",
"city": "WOODS CROSS",
"state": "UT",
"postal_code": "840872474",
"telephone_number": "801-913-5879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5974 FASHION POINT DR",
"address_2": "STE 100",
"city": "SOUTH OGDEN",
"state": "UT",
"postal_code": "844034699",
"telephone_number": "801-479-9644",
"fax_number": "801-479-9639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "KATHY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-16",
"last_updated": "2011-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "UT",
"license": "5597738-2402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.