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General NPI Number Information
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NPI Number | 1982988390
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Entity Type | Organization
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Legal Business Name | BULOW BIOTECH PROSTHETICS, LLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 10114 HUEBNER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1319
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Country | US
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Telephone | 210-614-4077
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Fax | 210-614-4075
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Provider Business Mailing Address
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Address Line | 102 WOODMONT BLVD SUITE 120
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City | NASHVILLE
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State | TN
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Zip | 37205-2287
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Country | US
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Telephone | 615-864-8788
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BRAD GARDNER
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Credential |
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Telephone | 615-864-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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