Provider Demographics
NPI:1700932985
Name:MULLER, ROSLYN (PT)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:
Last Name:MULLER
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 1:818 S GRAY EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8470
Mailing Address - Country:US
Mailing Address - Phone:208-331-0326
Mailing Address - Fax:
Practice Address - Street 1:818 S GRAY EAGLE WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8470
Practice Address - Country:US
Practice Address - Phone:208-331-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist