Provider Demographics
NPI:1013641745
Name:MCMULLAN, ARLIS
Entity Type:Individual
Prefix:
First Name:ARLIS
Middle Name:
Last Name:MCMULLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-5227
Mailing Address - Country:US
Mailing Address - Phone:325-315-1694
Mailing Address - Fax:
Practice Address - Street 1:12429 SCOFIELD FARMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2640
Practice Address - Country:US
Practice Address - Phone:325-315-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist