Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MM20560 | FL |
NPI | 1407144413 |
---|---|
Provider Name | Marie Mulhollan |
First Address | Tampa, FL 33609-3938 |
Second Address | Tampa, FL 33609-3938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |