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NPI Code Detail

MEDICARE: DAVID BRUCE MCCULLOUGH PTA

MEDICARE: DAVID BRUCE MCCULLOUGH 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 AssistantA-0268NV

General Provider Information

NPI Number : 1780811042
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BRUCE MCCULLOUGH PTA
Provider Business Mailing Address
First Line : PO BOX 41293
Second Line :
City : RENO
State : NV
Zip : 89504-5293
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3050 N ORMSBY BLVD
Second Line :
City : CARSON CITY
State : NV
Zip : 89703-8378
Country : US
Telephone Number : 775-841-4646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2009
Last Update Date : 06/14/2009

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