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NPI Code Detail

MEDICARE: MRS. LEAH K. BULLARD PTA

MEDICARE: MRS. LEAH K. BULLARD PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA20606FL

General Provider Information

NPI Number : 1104096114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEAH K. BULLARD PTA
Provider Business Mailing Address
First Line : 1153 GULF BREEZE PKWY
Second Line :
City : GULF BREEZE
State : FL
Zip : 32561-4835
Country : US
Telephone Number : 850-932-6382
Fax Number : 850-932-9215
Provider Business Practice Location Address
First Line : 5855 CREEK STATION DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-8626
Country : US
Telephone Number : 850-477-6966
Fax Number : 850-477-0267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2008
Last Update Date : 03/05/2008

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