Provider Demographics
NPI:1073039939
Name:MCMULLEN, CARLY FAYE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:FAYE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 19TH AVE STE 468
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1242
Mailing Address - Country:US
Mailing Address - Phone:303-830-0018
Mailing Address - Fax:303-830-3957
Practice Address - Street 1:1721 E 19TH AVE STE 468
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-830-0018
Practice Address - Fax:303-830-3957
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist