Individual
JACQUELYN R BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
880 HODGSON RD, COLUMBIA FALLS, MT 59912-9026
(406) 426-1560
(406) 510-2933
Mailing address
PO BOX 5086, WHITEFISH, MT 59937-5086
(715) 577-5041
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11116
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457834822
—
MT
Enumeration date
09/12/2018
Last updated
12/08/2023
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