Provider Demographics
NPI:1205901279
Name:BULLARD, CLAUDIA W (LPT)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:W
Last Name:BULLARD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1233
Mailing Address - Country:US
Mailing Address - Phone:361-358-9200
Mailing Address - Fax:361-362-1671
Practice Address - Street 1:1602 E HOUSTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5326
Practice Address - Country:US
Practice Address - Phone:361-358-9200
Practice Address - Fax:361-362-1671
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11323482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166806301Medicaid
TX84485TOtherBCBS
TX84485TOtherBCBS
TX166806301Medicaid