Provider Demographics
NPI:1902014244
Name:BULLOCK, KIMBERLY SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUE
Last Name:BULLOCK
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 1:348 PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3816
Mailing Address - Country:US
Mailing Address - Phone:614-447-9498
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHEL RD.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:ND
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-734-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT4991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist