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General NPI Number Information
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NPI Number | 1942830534
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Entity Type | Individual
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Provider Name | CHRISTEL ERIKA DE GUZMAN BULLIS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 2301 EASTERN AVE
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City | RED OAK
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State | IA
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Zip | 51566-1300
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Country | US
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Telephone | 702-623-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 NOTTINGHAM DR
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City | BELLEVUE
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State | NE
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Zip | 68123-1958
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 099390
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License Number State | IA
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