Provider Demographics
NPI:1891848685
Name:MULLIS, MERODIE ERIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MERODIE
Middle Name:ERIN
Last Name:MULLIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 N WOLFE RD
Mailing Address - Street 2:SW3 - 100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2515
Mailing Address - Country:US
Mailing Address - Phone:408-342-6600
Mailing Address - Fax:
Practice Address - Street 1:10080 N WOLFE RD
Practice Address - Street 2:SW3-100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2515
Practice Address - Country:US
Practice Address - Phone:408-342-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist