Provider Demographics
NPI:1598934572
Name:MULLINS, LINDA (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:315 E THIRD ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1830
Mailing Address - Country:US
Mailing Address - Phone:573-216-3371
Mailing Address - Fax:573-302-7165
Practice Address - Street 1:3 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-5786
Practice Address - Country:US
Practice Address - Phone:573-216-3371
Practice Address - Fax:573-302-7165
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000577225700000X
MO225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist