Carla J Bulla, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT23814 Issued in FL

Practice address

638 N Ferdon Blvd Ste 1
Crestview, FL 32536-2170

Phone

(850) 331-3017

Fax

(855) 975-2575

NPI assigned

Jan 10, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL, AL2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pro Vita Physical Therapy LLCGroup PAC ID 6901226976, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pro Vita Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Crestview, FL
  • NPI 1790332351

  AL, Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Pro Vita Physical Therapy LLC

  dba Pro Vita Physical Therapy - Milton

  • Physical Therapist
  • Milton, FL
  • NPI 1245945807
  Authorized official Same address or phone
• Pro Vita Physical Therapy LLC

  dba Pro Vita Physical Therapy - Shalimar

  • Physical Therapist
  • Fort Walton Beach, FL
  • NPI 1841944535
  Authorized official Same address or phone
• Pro Vita Physical Therapy LLC

  dba Pro Vita Physical Therapy - Pensacola

  • Physical Therapist
  • Pensacola, FL
  • NPI 1881404796
  Authorized official Same address or phone
• Pro Vita Physical Therapy - Florala

  • Physical Therapy Clinic/Center
  • Florala, AL
  • NPI 1053196568
  Authorized official Same address or phone
• Jacksonville Orthopaedic Institute Inc

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
  • NPI 1346298023

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704499200000",
    "number": "1558547406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 N MAIN ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325363510",
            "telephone_number": "850-331-3017",
            "fax_number": "855-975-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 N FERDON BLVD STE 1",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362170",
            "telephone_number": "850-331-3017",
            "fax_number": "855-975-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLA",
        "first_name": "CARLA",
        "middle_name": "J",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-10",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL2183",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT23814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103517900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Brown
• Kimberly Edwina Brown, PTA
• Troy Brown III, D.M.D.
• Tanner Brunnworth, DMD
• Justin Buchanan, D.M.D.
• Ryan Bullard, LCSW, BCD, PMH-C
• Kathryn Anne Burchfield, DMD
• Shelbi Burgett
• Stacy Burlison, LMHC
• Lisa D Burner, LCSW CAP

• Physical Therapist in Crestview, FL
• Providers in Crestview, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.