Healthcare Provider Details

I. General information

NPI: 1174877435
Provider Name (Legal Business Name): JAMI MULLINS P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 S SR 15A SUITE 2
DELAND FL
32720-7817
US

IV. Provider business mailing address

1590 S SR 15A SUITE 2
DELAND FL
32720-7817
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: