Provider Demographics
NPI:1750063517
Name:BULLARD, RANDI (DPT)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:BULLARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:LAYNE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12739 HIGHWAY 171 STE B
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70652-5050
Mailing Address - Country:US
Mailing Address - Phone:337-317-9290
Mailing Address - Fax:
Practice Address - Street 1:12739 HIGHWAY 171 STE B
Practice Address - Street 2:
Practice Address - City:LONGVILLE
Practice Address - State:LA
Practice Address - Zip Code:70652-5050
Practice Address - Country:US
Practice Address - Phone:337-317-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist