Individual
HEATHER BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
3825 OLD BRANDON RD, PEARL, MS 39208-4036
(601) 720-7206
(601) 724-5177
Mailing address
121 OAK DR, BRANDON, MS 39047-6201
(191) 079-7602
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P9280
NC
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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