Provider Demographics
NPI:1174622187
Name:PULLEY, JOHN JEFF (L-ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEFF
Last Name:PULLEY
Suffix:
Gender:M
Credentials:L-ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DREXEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5116
Mailing Address - Country:US
Mailing Address - Phone:325-224-0979
Mailing Address - Fax:
Practice Address - Street 1:115 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5770
Practice Address - Country:US
Practice Address - Phone:325-245-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer