Provider Demographics
NPI:1386083319
Name:MULLEN, LINDSEY N (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:N
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:1490 PANTOPS MOUNTAIN PL STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4601
Practice Address - Country:US
Practice Address - Phone:434-245-6472
Practice Address - Fax:434-245-6474
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherMEDICARE GROUP PTAN
VAVVA787AMedicare PIN