Provider Demographics
NPI:1487330817
Name:BULLS, PHILIP COREY
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:COREY
Last Name:BULLS
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 1:260 COLSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8748
Mailing Address - Country:US
Mailing Address - Phone:706-442-9022
Mailing Address - Fax:
Practice Address - Street 1:260 COLSON RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8748
Practice Address - Country:US
Practice Address - Phone:706-442-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282801225700000X
NC20746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist