Provider Demographics
NPI:1437295185
Name:MULLEN, DIANE MARION (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARION
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7108
Mailing Address - Country:US
Mailing Address - Phone:573-808-1017
Mailing Address - Fax:
Practice Address - Street 1:2102 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-7108
Practice Address - Country:US
Practice Address - Phone:573-808-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32141225100000X
GAPT008345225100000X
MO2001007196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist