Healthcare Provider Details

I. General information

NPI: 1255536751
Provider Name (Legal Business Name): KATE E BULLACH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E MILLTOWN RD
WOOSTER OH
44691-1255
US

IV. Provider business mailing address

1740 CLEVELAND RD
WOOSTER OH
44691-2204
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4580
  • Fax:
Mailing address:
  • Phone: 330-287-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 011789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: