Organization
PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BRIAN BULLARD DPT (PHYSICAL THERAPIST/OWNER/MANAGER)
(252) 916-9949
Entity
Organization
Contact information
Practice address
107 LIVE OAK ST, TABOR CITY, NC 28463-2042
(252) 916-9949
Mailing address
PO BOX 219, TABOR CITY, NC 28463-0219
(910) 377-3146
(910) 377-3277
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
10244
NC
Other
Enumeration date
07/20/2016
Last updated
02/06/2017
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