Provider Demographics
NPI:1497761720
Name:BULOW, MATTHEW (CP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BULOW
Suffix:
Gender:M
Credentials:CP
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MANAGER
Mailing Address - Street 1:708 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1958
Mailing Address - Country:US
Mailing Address - Phone:931-520-0244
Mailing Address - Fax:931-520-0241
Practice Address - Street 1:708 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1958
Practice Address - Country:US
Practice Address - Phone:931-520-0244
Practice Address - Fax:931-520-0241
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management