Provider Demographics
NPI:1376113464
Name:MULLIN, KIRSTEN ANGELA (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANGELA
Last Name:MULLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ANGELA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16350 WOODGATE RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-9501
Mailing Address - Country:US
Mailing Address - Phone:720-318-4246
Mailing Address - Fax:
Practice Address - Street 1:16350 WOODGATE RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-9501
Practice Address - Country:US
Practice Address - Phone:720-318-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225100000X
COPTL.0017762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist