Provider Demographics
NPI:1033496278
Name:BULLARD, LINDA CAROLINE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROLINE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:CAROLINE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 FIVE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1353
Mailing Address - Country:US
Mailing Address - Phone:615-305-4710
Mailing Address - Fax:615-453-3684
Practice Address - Street 1:610 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2121
Practice Address - Country:US
Practice Address - Phone:615-849-8550
Practice Address - Fax:615-849-8447
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000002693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant