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Individual

MR. JULIAN CRAIG MCCULLOCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
4971 GROOM RD, BAKER, LA 70714-3145
(225) 775-7051
(225) 774-7244
Mailing address
4971 GROOM RD, BAKER, LA 70714-3145
(225) 775-7051
(225) 774-7244

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-0307
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23651
BLUE CROSS PROVIDER #
LA
Enumeration date
01/23/2007
Last updated
07/08/2007
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