Provider Demographics
NPI:1386064822
Name:BULLARD, NATHON
Entity type:Individual
Prefix:
First Name:NATHON
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 COUNTY ROAD 33900
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-5026
Mailing Address - Country:US
Mailing Address - Phone:903-227-8081
Mailing Address - Fax:
Practice Address - Street 1:3815 COUNTY ROAD 33900
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:TX
Practice Address - Zip Code:75473-5026
Practice Address - Country:US
Practice Address - Phone:903-227-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist