Provider Demographics
NPI:1730377078
Name:BULLARD, SHEILA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BULLARD
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5941
Mailing Address - Country:US
Mailing Address - Phone:972-935-3156
Mailing Address - Fax:
Practice Address - Street 1:3295 N HIGHWAY 77 # 500
Practice Address - Street 2:SKILLSNET EXECUTIVE BUSINESS CTR.
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5736
Practice Address - Country:US
Practice Address - Phone:972-935-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT043818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist