Provider Demographics
NPI:1528432184
Name:MULLINNIX, JUSTINE MCCORMICK (PTA)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MCCORMICK
Last Name:MULLINNIX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 W BUTLER RD APT 412
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4814
Mailing Address - Country:US
Mailing Address - Phone:803-968-0045
Mailing Address - Fax:
Practice Address - Street 1:2006 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4005
Practice Address - Country:US
Practice Address - Phone:877-648-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3432225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3432OtherSC LLR