Healthcare Provider Details

I. General information

NPI: 1740093566
Provider Name (Legal Business Name): DENNIS MULLINS PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BROADWAY
ORONO ME
04473-4017
US

IV. Provider business mailing address

42 BROADWAY
ORONO ME
04473-4017
US

V. Phone/Fax

Practice location:
  • Phone: 207-949-3810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEXIS GAYLE IRELAND
Title or Position: EMPLOYEE
Credential:
Phone: 207-943-3494