Provider Demographics
NPI:1134666043
Name:BULL, ANA V (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:V
Last Name:BULL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:V
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 HILLCREST MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11862 S LONE STAR PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:TX
Practice Address - Zip Code:76557-3660
Practice Address - Country:US
Practice Address - Phone:512-988-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT72582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer