Provider Demographics
NPI:1184820805
Name:MULLEN, ANN E
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4619
Mailing Address - Country:US
Mailing Address - Phone:727-215-4063
Mailing Address - Fax:727-772-8202
Practice Address - Street 1:1478 JORDAN HILLS CT
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2368
Practice Address - Country:US
Practice Address - Phone:727-786-5520
Practice Address - Fax:727-786-7088
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist