Provider Demographics
NPI:1639648595
Name:MUELLER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MUELLER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-222-7421
Mailing Address - Street 1:2104 MANCHESTER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1889
Mailing Address - Country:US
Mailing Address - Phone:808-222-7421
Mailing Address - Fax:
Practice Address - Street 1:2104 MANCHESTER AVE APT B
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1889
Practice Address - Country:US
Practice Address - Phone:808-222-7421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty