Healthcare Provider Details

I. General information

NPI: 1265342844
Provider Name (Legal Business Name): KRISTIN CONSTANCE MULLEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PARROTT RD
WEST NYACK NY
10994-1025
US

IV. Provider business mailing address

33 GRAND ST
WARWICK NY
10990-1036
US

V. Phone/Fax

Practice location:
  • Phone: 845-627-4700
  • Fax:
Mailing address:
  • Phone: 845-492-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number008689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: