Active NPI
Joseph Bryan Bullard, PT
- Physical Therapist
- Conway, SC
National Provider Identifier
1265721815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4807
- Practice address
- 914 Norman St
Conway, SC 29526-5166 - Phone
- (843) 477-0177
- Fax
- (843) 488-1289
- NPI assigned
- Apr 5, 2011
- Sex
- Male
- 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 Therapist | 225100000X | 4807 | SC | Primary |
Addresses
Primary practice location
914 Norman St
Conway, SC 29526-5166
Mailing address
914 Norman St
Conway, SC 29526-5166
Phone (843) 477-0177
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 |
|---|---|---|---|
| 4807 | SC | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301961600000",
"number": "1265721815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 NORMAN ST",
"city": "CONWAY",
"state": "SC",
"postal_code": "295265166",
"telephone_number": "843-477-0177",
"fax_number": "843-488-1289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 NORMAN ST",
"city": "CONWAY",
"state": "SC",
"postal_code": "295265166",
"telephone_number": "843-477-0177",
"fax_number": "843-488-1289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARD",
"first_name": "JOSEPH",
"middle_name": "BRYAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-05",
"last_updated": "2011-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "4807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.