Provider Demographics
NPI:1518913755
Name:MULLINS, CHERI ELENA (PT)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:ELENA
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:ELENA
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:964 E LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:964 E LAREDO STREET
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8117
Practice Address - Country:US
Practice Address - Phone:480-688-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107817Medicare ID - Type Unspecified