Provider Demographics
NPI:1154713014
Name:MULLINS, LUCY (PT)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:MULLINS
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 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5555
Mailing Address - Country:US
Mailing Address - Phone:216-360-8060
Mailing Address - Fax:
Practice Address - Street 1:1 DAVID MYERS PKWY
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1162
Practice Address - Country:US
Practice Address - Phone:216-360-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist