MEDICARE: DEXTER S. MULLES P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16961	FL

General Provider Information

NPI Number	:	1972566438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEXTER S. MULLES P.T.

Provider Business Mailing Address
First Line	:	632 DEL PRADO BLVD N
Second Line	:	SUITE 101
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2278
Country	:	US
Telephone Number	:	239-772-5577
Fax Number	:	239-772-9961

Provider Business Practice Location Address
First Line	:	632 DEL PRADO BLVD N
Second Line	:	SUITE 101
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2278
Country	:	US
Telephone Number	:	239-772-5577
Fax Number	:	239-772-9961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	12/02/2015

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