Individual
NATALIE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3073
Mailing address
7823 BEECHWOOD FARMS DRIVE, AVON, IN 46123
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05004074A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05004074A
PT LICENSE
IN
Enumeration date
06/20/2008
Last updated
07/03/2008
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