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General NPI Number Information
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NPI Number | 1194946681
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN MULLEN LMT
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 KINDERHOOK STREET
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City | CHATHAM
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State | NY
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Zip | 12037
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Country | US
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Telephone | 518-392-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 61 DUNHAM HOLLOW ROAD
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City | EAST NASSAU
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State | NY
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Zip | 12062
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Country | US
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Telephone | 518-766-6457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 013056-1
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License Number State | NY
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