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General NPI Number Information
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NPI Number | 1558578302
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Entity Type | Individual
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Provider Name | CONSTANCE IRENE MCMULLEN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 210 BIG SPRING RD
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City | NEWVILLE
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State | PA
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Zip | 17241-9497
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Country | US
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Telephone | 171-776-8255
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Fax | 717-776-6266
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Provider Business Mailing Address
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Address Line | 519 E WINDING HILL RD
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City | MECHANICSBURG
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State | PA
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Zip | 17055-4911
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Country | US
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Telephone | 717-776-8255
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE001668L
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License Number State | PA
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