Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kevin James Bullock, PTA

Individual provider Physical Therapy Assistant · NPI 1003572082

Kevin James Bullock, PTA is a Physical Therapy Assistant in Desloge, Missouri. Practices as a sole proprietor. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

801 Brim St
Desloge, MO 63601-3441
Phone: (573) 431-0223
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X

Record details

NPI number1003572082
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorYes
NPI enumeratedNovember 13, 2021
Last updated in NPPESNovember 13, 2021
Certification dateNovember 13, 2021

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