Provider Demographics
NPI:1497127138
Name:MULLEN, QUENTIN ANTHONY (ATC)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:ANTHONY
Last Name:MULLEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 EARLY DR E
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3302
Mailing Address - Country:US
Mailing Address - Phone:937-613-7724
Mailing Address - Fax:
Practice Address - Street 1:444 EARLY DR E
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3302
Practice Address - Country:US
Practice Address - Phone:937-613-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program