Provider Demographics
NPI:1407000458
Name:MULHOLLAND, ANNA (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 BEACON ST # 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4494
Mailing Address - Country:US
Mailing Address - Phone:617-901-1311
Mailing Address - Fax:
Practice Address - Street 1:1693 BEACON ST # 1A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4494
Practice Address - Country:US
Practice Address - Phone:617-901-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1380OtherCOMMONWEALTH OF MASSACHUSETTS BOARD OF MASSAGE THERAPY