MEDICARE: SUZANNE LOUISE MULLIN PT

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
1	225100000X	Physical Therapist	19403	FL

General Provider Information

NPI Number	:	1134128002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LOUISE MULLIN PT

Provider Business Mailing Address
First Line	:	8337 BUENA VISTA RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-2678
Country	:	US
Telephone Number	:	239-278-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	8337 BUENA VISTA RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-2678
Country	:	US
Telephone Number	:	239-278-3501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	10/23/2008

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