Active NPI
Jeremy Bullock, PT
- Physical Therapist
- Winnsboro, TX
National Provider Identifier
1386906709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1124014
- Practice address
- 209 E Broadway St
Winnsboro, TX 75494-2604 - Phone
- (903) 342-6790
- NPI assigned
- Jun 12, 2012
- 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 | 1124014 | TX | Primary |
Addresses
Primary practice location
209 E Broadway St
Winnsboro, TX 75494-2604
Mailing address
3325 Adam LN
Greenville, TX 75402-3329
Phone (903) 513-4629
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 |
|---|---|---|---|
| 1124014 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1386906709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3325 ADAM LN",
"city": "GREENVILLE",
"state": "TX",
"postal_code": "754023329",
"telephone_number": "903-513-4629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 E BROADWAY ST",
"city": "WINNSBORO",
"state": "TX",
"postal_code": "754942604",
"telephone_number": "903-342-6790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "JEREMY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-12",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1124014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnsboro, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.