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NPI Code Detail

MEDICARE: AMY ELIZABETH MCMULLEN DPT

MEDICARE: AMY ELIZABETH MCMULLEN DPT
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
1225100000XPhysical Therapist3354NM

General Provider Information

NPI Number : 1487702874
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELIZABETH MCMULLEN DPT
Provider Business Mailing Address
First Line : 433 CARLISLE BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-1320
Country : US
Telephone Number : 505-459-6845
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MIEL DE LUNA AVE
Second Line :
City : TUCUMCARI
State : NM
Zip : 88401-3810
Country : US
Telephone Number : 505-461-7230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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