Individual
KATHY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5974 FASHION POINT DR, STE 100, SOUTH OGDEN, UT 84403-4699
(801) 479-9644
(801) 479-9639
Mailing address
1892 W 1590 S, WOODS CROSS, UT 84087-2474
(801) 913-5879
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5597738-2402
UT
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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