1366685257 NPI number — MULLIS AND ASSOCIATES PHYSICAL THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366685257 NPI number — MULLIS AND ASSOCIATES PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULLIS AND ASSOCIATES PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366685257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 ODONNELL SQ
Provider Second Line Business Mailing Address:
1
Provider Business Mailing Address City Name:
DORCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02122-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-519-6443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-519-6443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MULLIS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
617-519-6443

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  15359 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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