Individual
JEFFREY DALE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2016 SAN JACINTO RD, CAMP PENDLETON, CA 92054
(760) 719-4191
(760) 719-4267
Mailing address
2016 SAN JACINTO RD, CAMP PENDLETON, CA 92054
(760) 719-4191
(760) 719-4267
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PTL.0011340
CO
2251N0400X
Neurology Physical Therapist
Primary
0011340
CO
Other
Enumeration date
10/17/2007
Last updated
05/16/2024
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