Provider Demographics
NPI:1598219156
Name:MCMULLEN, DEANNA (DPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:FAHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 BLADES FARM RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-3489
Mailing Address - Country:US
Mailing Address - Phone:410-479-3300
Mailing Address - Fax:410-479-3382
Practice Address - Street 1:1140 BLADES FARM RD STE 201
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-3300
Practice Address - Fax:410-479-3382
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
MD26385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist