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NPI Code Detail

MEDICARE: DESTINEE MULLINIX PTA

MEDICARE: DESTINEE MULLINIX PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2018026836MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12018026836OTHERMOPTA

General Provider Information

NPI Number : 1093271298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINEE MULLINIX PTA
Provider Business Mailing Address
First Line : 8477 S SUNCOAST BLVD
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5028
Country : US
Telephone Number : 800-381-0822
Fax Number : 352-565-5201
Provider Business Practice Location Address
First Line : 1105 VILLAGE RD
Second Line :
City : NEOSHO
State : MO
Zip : 64850-9076
Country : US
Telephone Number : 800-381-0822
Fax Number : 352-565-5201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2019
Last Update Date : 03/03/2025

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Directions to “ DESTINEE MULLINIX PTA” Practice Location

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