Provider Demographics
NPI:1366529497
Name:MULLINS, BRIAN MELVIN (MS, PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MELVIN
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 WAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2735
Mailing Address - Country:US
Mailing Address - Phone:732-922-6618
Mailing Address - Fax:732-922-6619
Practice Address - Street 1:788 WAYSIDE RD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2735
Practice Address - Country:US
Practice Address - Phone:732-922-6618
Practice Address - Fax:732-922-6619
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA0859400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066208RCFMedicare ID - Type UnspecifiedBRIAN MEDICARE NUMBER