Provider Demographics
NPI:1518128651
Name:MULLES, ELENITA MASAMONG (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELENITA
Middle Name:MASAMONG
Last Name:MULLES
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 1:13831 SILVER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5676
Mailing Address - Country:US
Mailing Address - Phone:239-561-4637
Mailing Address - Fax:
Practice Address - Street 1:13831 SILVER LAKE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-5676
Practice Address - Country:US
Practice Address - Phone:239-561-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist