Healthcare Provider Details

I. General information

NPI: 1154650612
Provider Name (Legal Business Name): AMY BUZZELL MULLINS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2009
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 EASTMAN RD STE C
CENTER CONWAY NH
03813-4219
US

IV. Provider business mailing address

90 OAK RIDGE EST
MORRISVILLE VT
05661-4467
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-4356
  • Fax: 603-447-4358
Mailing address:
  • Phone: 802-888-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0400003255
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4147
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: