Provider Demographics
NPI:1801378930
Name:MULLEN, MAUREEN KELLY (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:KELLY
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2201
Mailing Address - Country:US
Mailing Address - Phone:508-992-4308
Mailing Address - Fax:508-992-4193
Practice Address - Street 1:200 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2201
Practice Address - Country:US
Practice Address - Phone:508-992-4308
Practice Address - Fax:508-992-4193
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist