Provider Demographics
NPI:1003834912
Name:BULEY, BRUCE (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BULEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TIMBERHILL PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1586
Mailing Address - Country:US
Mailing Address - Phone:919-967-5959
Mailing Address - Fax:919-968-1478
Practice Address - Street 1:115 TIMBERHILL PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1586
Practice Address - Country:US
Practice Address - Phone:919-967-5959
Practice Address - Fax:919-968-1478
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1152OtherNC STATE LICENSURE NUMBER
NC720783RMedicaid
NC1152OtherNC STATE LICENSURE NUMBER