Provider Demographics
NPI:1619216868
Name:MCNULTY, MAUREEN (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13358 ORTON RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8612
Mailing Address - Country:US
Mailing Address - Phone:530-274-3762
Mailing Address - Fax:
Practice Address - Street 1:13358 ORTON RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8612
Practice Address - Country:US
Practice Address - Phone:530-274-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist