Provider Demographics
NPI:1215209655
Name:MULLENIX, SHAUNA J (PT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:J
Last Name:MULLENIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1655 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3494
Mailing Address - Country:US
Mailing Address - Phone:702-914-2790
Mailing Address - Fax:702-914-5984
Practice Address - Street 1:1470 E CALVADA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3905
Practice Address - Country:US
Practice Address - Phone:775-537-2300
Practice Address - Fax:775-537-2345
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist