Provider Demographics
NPI:1053573139
Name:BULLA, JUDY C (PTA)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:C
Last Name:BULLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3397
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28564-3397
Mailing Address - Country:US
Mailing Address - Phone:252-672-1644
Mailing Address - Fax:252-672-5034
Practice Address - Street 1:2600 OLD CHERRY POINT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6778
Practice Address - Country:US
Practice Address - Phone:252-672-1644
Practice Address - Fax:252-672-5034
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant