=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598934572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA MULLINS L.M.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2008
-----------------------------------------------------
Last Update Date | 05/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 WALNUT GROVE RD
-----------------------------------------------------
City | ELDON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65026-5786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-216-3371
-----------------------------------------------------
Fax | 573-302-7165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 E THIRD ST
-----------------------------------------------------
City | ELDON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65026-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-216-3371
-----------------------------------------------------
Fax | 573-302-7165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 2002000577
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------