Provider Demographics
NPI:1568943363
Name:MUELLNER, RENEE LYNE (PTA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNE
Last Name:MUELLNER
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 1:310 S JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3039
Mailing Address - Country:US
Mailing Address - Phone:972-727-5850
Mailing Address - Fax:
Practice Address - Street 1:310 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3039
Practice Address - Country:US
Practice Address - Phone:972-727-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037745225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty