Provider Demographics
NPI:1073683801
Name:MULLENNAX, JAMES ADAM (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ADAM
Last Name:MULLENNAX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BOW HUNTER COURT
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078
Mailing Address - Country:US
Mailing Address - Phone:803-556-3610
Mailing Address - Fax:
Practice Address - Street 1:1202 MILL STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-1147
Practice Address - Fax:803-432-1149
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist