Provider Demographics
NPI:1073989612
Name:BULGER, SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:BULGER
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 1:2425 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5011
Mailing Address - Country:US
Mailing Address - Phone:817-510-4083
Mailing Address - Fax:817-510-0185
Practice Address - Street 1:2425 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5011
Practice Address - Country:US
Practice Address - Phone:817-510-4083
Practice Address - Fax:817-510-0185
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1262117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX437974YTNBOtherMEDICARE PTAN