Individual
KEVIN JAMES BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
801 BRIM ST, DESLOGE, MO 63601-3441
(573) 431-0223
Mailing address
801 BRIM ST, DESLOGE, MO 63601-3441
(573) 431-0223
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
11/13/2021
Last updated
11/13/2021
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