Healthcare Provider Details

I. General information

NPI: 1013502582
Provider Name (Legal Business Name): ERIN MCMULLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S STE 200
SOUTH JORDAN UT
84095-4713
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171-1185
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-2210
  • Fax:
Mailing address:
  • Phone: 801-942-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12146761-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: