Provider Demographics
NPI:1801016142
Name:MULLANE, FELICIA HELENE
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:HELENE
Last Name:MULLANE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:HELENE
Other - Last Name:MULLANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT,CMTPT
Mailing Address - Street 1:13776 CENTERLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-9790
Mailing Address - Country:US
Mailing Address - Phone:716-655-6131
Mailing Address - Fax:716-655-6131
Practice Address - Street 1:13776 CENTERLINE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH WALES
Practice Address - State:NY
Practice Address - Zip Code:14139-9790
Practice Address - Country:US
Practice Address - Phone:716-655-6131
Practice Address - Fax:716-655-6131
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6921Medicare PIN