Provider Demographics
NPI:1598989865
Name:BULLABOUGH, RHONDA ARLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:ARLEEN
Last Name:BULLABOUGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2834
Mailing Address - Country:US
Mailing Address - Phone:336-391-5390
Mailing Address - Fax:
Practice Address - Street 1:10949 PARNU ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-1405
Practice Address - Country:US
Practice Address - Phone:239-592-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23407225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant