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General NPI Number Information
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NPI Number | 1215307806
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Entity Type | Individual
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Provider Name | CORINNE BULLICK LMT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 418 HARRIS ST
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City | JUNEAU
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State | AK
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Zip | 99801-1083
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Country | US
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Telephone | 907-321-7781
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21161
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City | JUNEAU
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State | AK
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Zip | 99802-1161
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Country | US
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Telephone | 907-321-7781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 101366
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License Number State | AK
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