Provider Demographics
NPI:1265665582
Name:MULLINS, SAMATHA JO (LMT)
Entity Type:Individual
Prefix:
First Name:SAMATHA
Middle Name:JO
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7006 HARVEST GOLD WAY
Mailing Address - Street 2:APT # 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-5757
Mailing Address - Country:US
Mailing Address - Phone:859-582-7593
Mailing Address - Fax:
Practice Address - Street 1:7006 HARVEST GOLD WAY
Practice Address - Street 2:APT # 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-5757
Practice Address - Country:US
Practice Address - Phone:859-582-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY-2536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist