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Individual

LEAH ANN BULOW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSPT

Contact information

Practice address
2230 TOWNE LAKE PKWY, BLDG. 1200, SUITES 100 & 110, WOODSTOCK, GA 30189-5540
(770) 926-2744
(770) 926-2794
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7777
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
507154480A
GA
05
507154480B
GA
01
985629
BCBS GA
GA
01
985630
BCBS GA
GA
01
985631
BCBS GA
GA
Enumeration date
05/31/2006
Last updated
07/25/2011
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