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General NPI Number Information
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NPI Number | 1578386991
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Entity Type | Individual
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Provider Name | JACQUELINE ROSE MULLOY
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 154 E MAIN ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-1768
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Country | US
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Telephone | 508-366-7899
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Fax |
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Provider Business Mailing Address
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Address Line | 20 DIPIETRO LN
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City | BRISTOL
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State | CT
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Zip | 06010-7844
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Country | US
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Telephone | 631-339-3446
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0020375
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL28092
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License Number State | MA
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