Provider Demographics
NPI:1770607004
Name:MULEA, MICHAEL GARY (LPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GARY
Last Name:MULEA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SKYTOP DR
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1052
Mailing Address - Country:US
Mailing Address - Phone:570-457-7449
Mailing Address - Fax:570-457-7449
Practice Address - Street 1:213 SKYTOP DR
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1052
Practice Address - Country:US
Practice Address - Phone:570-457-7449
Practice Address - Fax:570-457-7449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008139L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist