Provider Demographics
NPI:1285067504
Name:BULLOCK, AMY N (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:N
Last Name:BULLOCK
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-7552
Mailing Address - Country:US
Mailing Address - Phone:980-272-8044
Mailing Address - Fax:
Practice Address - Street 1:10000 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7552
Practice Address - Country:US
Practice Address - Phone:980-272-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8978225100000X
NCP14397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12594991OtherINDIVIDUAL NPI