Lori Bullock, RPT
Individual provider Active NPI Specialist · Marshfield, MO
NPI 1821178989 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821178989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 109731 (MO)
- Practice address
- 106 N Crittenden St
Marshfield, MO 65706-1408 - Phone
- (417) 859-3991
- Fax
- (417) 859-0100
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109731 | MO | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Physical Therapy Associates Inc. | Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 109731 | MO | Yes |
Addresses
Primary practice location
106 N Crittenden St
Marshfield, MO 65706-1408
Mailing address
1911 S National Ave
Suite 302
Springfield, MO 65804-2219
Phone (417) 881-4164
Other providers in Marshfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.