Provider Demographics
NPI:1275297087
Name:MULLINS, HEATHER LYNN (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:78947-0256
Mailing Address - Country:US
Mailing Address - Phone:636-795-0964
Mailing Address - Fax:833-413-2036
Practice Address - Street 1:616 WHEATLEY ST.
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TX
Practice Address - Zip Code:78947
Practice Address - Country:US
Practice Address - Phone:636-795-0964
Practice Address - Fax:833-413-2036
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1303950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist