Provider Demographics
NPI:1023039781
Name:MULLINS, NANCY A (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-7448
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-7448
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650019673OtherRR MEDICARE
000000217253OtherANTHEM BCBS
OH2221125OtherMOLINA MEDICAID
WV0156117000Medicaid
000000204584OtherOH MEDICAID - UNISON
310917085311OtherMOUNTAIN STATE BCBS
310917085311OtherMOUNTAIN STATE BCBS
WV0156117000Medicaid