Healthcare Provider Details

I. General information

NPI: 1598934572
Provider Name (Legal Business Name): LINDA MULLINS L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA JEAN MULLINS P.T.A.

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 05/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT GROVE RD
ELDON MO
65026-5786
US

IV. Provider business mailing address

315 E THIRD ST
ELDON MO
65026-1830
US

V. Phone/Fax

Practice location:
  • Phone: 573-216-3371
  • Fax: 573-302-7165
Mailing address:
  • Phone: 573-216-3371
  • Fax: 573-302-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2002000577
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: