Provider Demographics
NPI:1134128002
Name:MULLIN, SUZANNE LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LOUISE
Last Name:MULLIN
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 1:8337 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2678
Mailing Address - Country:US
Mailing Address - Phone:239-278-3501
Mailing Address - Fax:
Practice Address - Street 1:8337 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-2678
Practice Address - Country:US
Practice Address - Phone:239-278-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist