Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2057560 | TX |
NPI | 1023135829 |
---|---|
Provider Name | Mark Mullins |
First Address | Keller, TX 76248-0919 |
Second Address | Keller, TX 76248-0919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 08/07/2007 |