| Doctor Name: | MRS. SANDRA BULLOCK |
| NPI Number: | 1265631428 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICAL THERAPIST |
| License Number: | 01648 |
| Business Practice Address: | 1005 Johnson St Tallulah, LA - 712825215 |
| Business Phone Number: | 3185745273 |
| Business Fax Number: | 3185742218 |
| Mailing Address: | 1901 Mission 66, Suite A VICKSBURG |
| State: | MS |
| Postal Code: | 391803711 |
| Phone Number: | 6016384076 |
| Fax Number: | 6016384979 |
| NPI Enumeration Date: | 07/17/2007 |
| NPI Last Update Date: | 07/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 01648 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |