Provider Demographics
NPI:1154539419
Name:MULLEN, PEGGY ARLENE (PT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ARLENE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:KIRWIN
Mailing Address - State:KS
Mailing Address - Zip Code:67644-3527
Mailing Address - Country:US
Mailing Address - Phone:785-543-7111
Mailing Address - Fax:
Practice Address - Street 1:1062 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:KIRWIN
Practice Address - State:KS
Practice Address - Zip Code:67644-3527
Practice Address - Country:US
Practice Address - Phone:785-543-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00338225100000X
NE1792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist