Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | P6771 | NC |
NPI | 1467993410 |
---|---|
Provider Name | Kerry Mullenix |
First Address | Hillsborough, NC 27278-7324 |
Second Address | Durham, NC 27708-9982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2017 |
Last Update Date | 10/03/2017 |