Charles Edward Bouldin, R.P.T.

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT0198 Issued in MS

Practice address

4749 S Eason Blvd
Suite a
Tupelo, MS 38801-6547

Phone

(662) 842-3336

Fax

(662) 842-3363

NPI assigned

Mar 22, 2007

Last updated

Nov 8, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1679690101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4749 S EASON BLVD",
            "address_2": "SUITE A",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016547",
            "telephone_number": "662-842-3336",
            "fax_number": "662-842-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 S EASON BLVD",
            "address_2": "SUITE A",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016547",
            "telephone_number": "662-842-3336",
            "fax_number": "662-842-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "R.P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "PT0198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Bonner, M.ED.
• Carla Booker, SLP
• Katelyn C Boren
• Samantha Grace Boren, PMHNP-BC
• Sharon Dugas Boudreaux, BCBA
• Keisha Bounds
• Makenna Bourland, PA-C
• Kevin Boutin, O.T.
• Ronondo Jerome Bowen, MS
• Ashley Shanea Bowens, PMHNP

• Specialist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.