Provider Demographics
NPI:1013950872
Name:MULLEN, MARIE (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:RANISZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4102 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4183
Practice Address - Country:US
Practice Address - Phone:302-894-1800
Practice Address - Fax:302-894-1811
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1610024OtherPABS
76915007OtherNCA
DE1000037719Medicaid
2287552000OtherAMERIHEALTH
5070-0012OtherCARE FIRST
2287552000OtherAMERIHEALTH
5070-0012OtherCARE FIRST
DEG02378A07Medicare UPIN
1610024OtherPABS
DE007175F68Medicare ID - Type Unspecified