Healthcare Provider Details

I. General information

NPI: 1538344551
Provider Name (Legal Business Name): EDWARD JOHN MULLOY R.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 MIRAMAR ST SUITE B/C
CAPE CORAL FL
33904-9047
US

IV. Provider business mailing address

218 GLEASON PKWY
CAPE CORAL FL
33914-5054
US

V. Phone/Fax

Practice location:
  • Phone: 239-540-7900
  • Fax: 239-540-2140
Mailing address:
  • Phone: 239-850-8485
  • Fax: 239-540-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRT 5888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: