Healthcare Provider Details

I. General information

NPI: 1366529497
Provider Name (Legal Business Name): BRIAN MELVIN MULLINS MS., PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 WAYSIDE RD
NEPTUNE NJ
07753-2735
US

IV. Provider business mailing address

788 WAYSIDE RD
NEPTUNE NJ
07753-2735
US

V. Phone/Fax

Practice location:
  • Phone: 732-922-6618
  • Fax: 732-922-6619
Mailing address:
  • Phone: 732-922-6618
  • Fax: 732-922-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA0859400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: