Provider Demographics
NPI:1699002444
Name:MICHAEL G. MULEA PT IN HOME THERAPY SERVICES
Entity Type:Organization
Organization Name:MICHAEL G. MULEA PT IN HOME THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:MULEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-905-0280
Mailing Address - Street 1:213 SKYTOP DR
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1052
Mailing Address - Country:US
Mailing Address - Phone:570-905-0280
Mailing Address - Fax:570-457-7449
Practice Address - Street 1:213 SKYTOP DR
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1052
Practice Address - Country:US
Practice Address - Phone:570-905-0280
Practice Address - Fax:570-457-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-14
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008139L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110058Medicare UPIN