Provider Demographics
NPI:1891021697
Name:MUSTEEN, MARNA (PT)
Entity type:Individual
Prefix:
First Name:MARNA
Middle Name:
Last Name:MUSTEEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9366 GLENDA RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-9796
Mailing Address - Country:US
Mailing Address - Phone:931-249-1847
Mailing Address - Fax:
Practice Address - Street 1:9366 GLENDA RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-9796
Practice Address - Country:US
Practice Address - Phone:931-249-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005167225100000X
AR5421225100000X
TN7924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist