Provider Demographics
NPI:1619232659
Name:BULSON, SARA (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BULSON
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 E DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2113
Mailing Address - Country:US
Mailing Address - Phone:303-818-9575
Mailing Address - Fax:
Practice Address - Street 1:1532 E DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2113
Practice Address - Country:US
Practice Address - Phone:303-818-9575
Practice Address - Fax:480-992-9311
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13679225700000X
AZ23-1795175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist