Provider Demographics
NPI:1649681081
Name:MULLINIX, JACLYN NICOLE (PT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:NICOLE
Last Name:MULLINIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:NICOLE
Other - Last Name:STRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:512 TREMONT ST
Practice Address - Street 2:STE A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4178
Practice Address - Country:US
Practice Address - Phone:423-529-3127
Practice Address - Fax:423-668-9983
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist