Kevin James Bullock, PTA

NPI #1003572082 in Desloge, Missouri

Provider Information

NPI Number: 1003572082
Entity Type: Individual
Name: Kevin James Bullock, PTA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Nov 13, 2021
Last Updated: Nov 13, 2021

Practice Location

Address: 801 BRIM ST
City: Desloge
State: Missouri
ZIP Code: 63601-3441
Phone: (573) 431-0223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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