Provider Demographics
NPI:1972011252
Name:MUELLER, CARLY JANAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:JANAE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 77TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2448
Mailing Address - Country:US
Mailing Address - Phone:201-572-2573
Mailing Address - Fax:
Practice Address - Street 1:304 E 77TH ST APT 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2448
Practice Address - Country:US
Practice Address - Phone:201-572-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist