Provider Demographics
NPI:1962523407
Name:MULHOLLAND, DENISE ANN (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:MULHOLLAND
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 1:161 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3509
Mailing Address - Country:US
Mailing Address - Phone:610-449-5156
Mailing Address - Fax:
Practice Address - Street 1:3975 CONSHOHOCKEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5426
Practice Address - Country:US
Practice Address - Phone:215-879-1000
Practice Address - Fax:215-879-3912
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002800L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019235730001Medicaid