Provider Demographics
NPI:1538344551
Name:MULLOY, EDWARD JOHN (RRT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:MULLOY
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:218 GLEASON PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5054
Mailing Address - Country:US
Mailing Address - Phone:239-850-8485
Mailing Address - Fax:239-540-9426
Practice Address - Street 1:909 MIRAMAR ST
Practice Address - Street 2:SUITE B/C
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9047
Practice Address - Country:US
Practice Address - Phone:239-540-7900
Practice Address - Fax:239-540-2140
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 5888227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified