Provider Demographics
NPI:1639328354
Name:BULAWAN, KARMIEL (PT)
Entity Type:Individual
Prefix:MS
First Name:KARMIEL
Middle Name:
Last Name:BULAWAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8779 SPRING MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9676
Mailing Address - Country:US
Mailing Address - Phone:239-275-7285
Mailing Address - Fax:239-275-7285
Practice Address - Street 1:8779 SPRING MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9676
Practice Address - Country:US
Practice Address - Phone:239-275-7285
Practice Address - Fax:239-275-7285
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist