Provider Demographics
NPI:1194029470
Name:MULLAN, SHAUN T (CMT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:T
Last Name:MULLAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CONCHESTER HWY
Mailing Address - Street 2:SUTIE 14
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2124
Mailing Address - Country:US
Mailing Address - Phone:484-842-1441
Mailing Address - Fax:
Practice Address - Street 1:1440 CONCHESTER HWY
Practice Address - Street 2:SUTIE 14
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19060-2124
Practice Address - Country:US
Practice Address - Phone:484-842-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist