Provider Demographics
NPI:1316291032
Name:MULLINS, CHRISTINE S (LPTA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CONNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:580 N TELEGRAPH RD UNIT B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3337
Practice Address - Country:US
Practice Address - Phone:734-430-8330
Practice Address - Fax:734-430-8331
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003717225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant