Provider Demographics
NPI:1568704799
Name:MULLEN, GARY JOHN (DPT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:MULLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 LOCHINVAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5108
Mailing Address - Country:US
Mailing Address - Phone:408-905-6483
Mailing Address - Fax:
Practice Address - Street 1:3530 LOCHINVAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5108
Practice Address - Country:US
Practice Address - Phone:408-173-7538
Practice Address - Fax:408-479-3835
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245572486Medicaid