Provider Demographics
NPI:1710686936
Name:MULLEN, MARGUERITE A (PT)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:A
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:
Other - Last Name:STATHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:511 OLD LANCASTER RD STE 12
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1671
Mailing Address - Country:US
Mailing Address - Phone:484-919-5601
Mailing Address - Fax:
Practice Address - Street 1:511 OLD LANCASTER RD STE 12
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1671
Practice Address - Country:US
Practice Address - Phone:484-919-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist