NPI 1679690101

Charles Edward Bouldin, RPT

Practitioner Specialist Tupelo, MS

Practice location

Address: 4749 S Eason Blvd Suite a, Tupelo, MS 38801-6547
Phone: (662) 842-3336
Fax: (662) 842-3363

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence PT0198 (MS)

Other Specialist providers in Mississippi →

Registry record

NPI: 1679690101
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Mar 2007
Record last updated: 8 Nov 2010

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.