Healthcare Provider Details

I. General information

NPI: 1134332059
Provider Name (Legal Business Name): BULOW BIOTECH PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 2ND ST SUITE A
CLARKSVILLE TN
37040-1917
US

IV. Provider business mailing address

102 WOODMONT BLVD SUITE 120
NASHVILLE TN
37205-2287
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-0244
  • Fax: 931-520-0241
Mailing address:
  • Phone: 615-864-8788
  • Fax: 615-454-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD NEIL GARDNER
Title or Position: COO
Credential:
Phone: 615-864-8783