Provider Demographics
NPI:1558578302
Name:MCMULLEN, CONSTANCE IRENE (PTA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:IRENE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E WINDING HILL RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4911
Mailing Address - Country:US
Mailing Address - Phone:717-776-8255
Mailing Address - Fax:
Practice Address - Street 1:210 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-9497
Practice Address - Country:US
Practice Address - Phone:171-776-8255
Practice Address - Fax:717-776-6266
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001668L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant