Individual
MRS. WANDA MAE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
TROY ROAD, WASHINGTON, IN 47501
(812) 254-8500
Mailing address
TROY ROAD, WASHINGTON, IN 47501
(812) 254-9500
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06000569A
IN
Other
Enumeration date
06/03/2010
Last updated
06/03/2010
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