NPI 1003572082

Kevin James Bullock, PTA

Practitioner Physical Therapy Assistant Desloge, MO

Practice location

Address: 801 Brim St, Desloge, MO 63601-3441
Phone: (573) 431-0223

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X

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Registry record

NPI: 1003572082
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Nov 2021
Record last updated: 13 Nov 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.