Provider Demographics
NPI:1386523272
Name:MULLIS, KLAY (PTA)
Entity type:Individual
Prefix:
First Name:KLAY
Middle Name:
Last Name:MULLIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:139 GA HIGHWAY 32 BYP
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2757
Mailing Address - Country:US
Mailing Address - Phone:912-632-6321
Mailing Address - Fax:912-632-6322
Practice Address - Street 1:139 GA HIGHWAY 32 BYP
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2757
Practice Address - Country:US
Practice Address - Phone:912-632-6321
Practice Address - Fax:912-632-6322
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA005404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant