Basic Information
| Provider Information | |||||||||
| NPI: | 1366908295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULAWIN | ||||||||
| FirstName: | CYRIL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 JOHNSON DR | ||||||||
| Address2: | |||||||||
| City: | MC GREGOR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766571426 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 414 JOHNSON DR | ||||||||
| Address2: | |||||||||
| City: | MC GREGOR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766571426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548403281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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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 | 2251G0304X | 1085835 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.