Provider Demographics
NPI:1861835696
Name:MULLES, MAYFLOR Q (PT)
Entity Type:Individual
Prefix:
First Name:MAYFLOR
Middle Name:Q
Last Name:MULLES
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 1:3210 CLEVELAND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-936-6778
Mailing Address - Fax:239-936-1246
Practice Address - Street 1:3210 CLEVELAND AVE
Practice Address - Street 2:STE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7182
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:239-936-1246
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHC590ZMedicare PIN