Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1085835 | TX |
NPI | 1366908295 |
---|---|
Provider Name | Cyril D Bulawin |
First Address | Mc Gregor, TX 76657-1426 |
Second Address | Mc Gregor, TX 76657-1426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2019 |
Last Update Date | 15/02/2019 |