Provider Demographics
NPI:1336203157
Name:BULOS, CHERIS (MPT)
Entity type:Individual
Prefix:MRS
First Name:CHERIS
Middle Name:
Last Name:BULOS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 OVERLAND AVE
Mailing Address - Street 2:UNIT 315
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4289
Mailing Address - Country:US
Mailing Address - Phone:310-717-5238
Mailing Address - Fax:310-280-0305
Practice Address - Street 1:4900 OVERLAND AVE
Practice Address - Street 2:UNIT 315
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4289
Practice Address - Country:US
Practice Address - Phone:310-717-5238
Practice Address - Fax:310-280-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist