Provider Demographics
NPI:1881982080
Name:BULLINGER, BLAIR MICHAEL (MMT, NTS)
Entity type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:MICHAEL
Last Name:BULLINGER
Suffix:
Gender:M
Credentials:MMT, NTS
Other - Prefix:MR
Other - First Name:BLAIR
Other - Middle Name:MICHAEL
Other - Last Name:GARCIA-BULLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MMT, NTS
Mailing Address - Street 1:6601 KATHRYN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4933
Mailing Address - Country:US
Mailing Address - Phone:505-206-9702
Mailing Address - Fax:
Practice Address - Street 1:316 MADISON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1243
Practice Address - Country:US
Practice Address - Phone:505-206-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6984172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist