Healthcare Provider Details

I. General information

NPI: 1366889941
Provider Name (Legal Business Name): ELIZABETH BULLMER C.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 S WESTNEDGE AVE
KALAMAZOO MI
49008-2903
US

IV. Provider business mailing address

4704 CEDARCREST AVE
PORTAGE MI
49024-9576
US

V. Phone/Fax

Practice location:
  • Phone: 269-567-0473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: