Provider Demographics
NPI:1558325076
Name:ULLERY, LARRY ROBERT (ATC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ROBERT
Last Name:ULLERY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 KITTIWAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3835
Mailing Address - Country:US
Mailing Address - Phone:859-245-0768
Mailing Address - Fax:
Practice Address - Street 1:601 PERIMETER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4121
Practice Address - Country:US
Practice Address - Phone:859-323-5533
Practice Address - Fax:859-257-0168
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT1952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer