Provider Demographics
NPI:1992094239
Name:MULLINS, CAROLYN SLAY (LPT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SLAY
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12457 TIMBERLAND BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5210
Mailing Address - Country:US
Mailing Address - Phone:817-602-9298
Mailing Address - Fax:
Practice Address - Street 1:12457 TIMBERLAND BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5210
Practice Address - Country:US
Practice Address - Phone:817-602-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10615052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics