Individual
MS. LAURA ANNE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1705 N VALLEY DR, SUITE 2, LAS CRUCES, NM 88007-5121
(575) 650-6113
Mailing address
4053 SHADOW RUN AVE, LAS CRUCES, NM 88011-9681
(575) 650-6113
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
4715
NM
Other
Enumeration date
11/06/2007
Last updated
11/06/2007
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