Provider Demographics
NPI:1639805583
Name:MULLIN, CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6004
Mailing Address - Country:US
Mailing Address - Phone:571-358-4091
Mailing Address - Fax:
Practice Address - Street 1:50 DUNN DR STE 117
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1500
Practice Address - Country:US
Practice Address - Phone:571-358-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011207225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist