Provider Demographics
NPI:1396992822
Name:MCMULLEN, CALDWELL S (RPT)
Entity type:Individual
Prefix:MR
First Name:CALDWELL
Middle Name:S
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8268
Mailing Address - Country:US
Mailing Address - Phone:208-265-0610
Mailing Address - Fax:208-265-9192
Practice Address - Street 1:1301 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8268
Practice Address - Country:US
Practice Address - Phone:208-265-0610
Practice Address - Fax:208-265-9192
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist