Basic Information
| Provider Information | |||||||||
| NPI: | 1003834912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULEY | ||||||||
| FirstName: | BRUCE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 TIMBERHILL PL | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275141586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199675959 | ||||||||
| FaxNumber: | 9199681478 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 TIMBERHILL PL | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275141586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199675959 | ||||||||
| FaxNumber: | 9199681478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 1152 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 1152 | 01 | NC | NC STATE LICENSURE NUMBER | OTHER | 720783R | 05 | NC | MEDICAID |