Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06004556A | IN |
NPI | 1760726152 |
---|---|
Provider Name | Mrs. Tracy Mullins |
First Address | Lousiville, KY 40222 |
Second Address | Lousiville, KY 40222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |