Provider Demographics
NPI:1538221411
Name:MULLANEY, JOAN B (RPT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:B
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2328
Mailing Address - Country:US
Mailing Address - Phone:860-875-8998
Mailing Address - Fax:
Practice Address - Street 1:384 MERROW RD STE B
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3971
Practice Address - Country:US
Practice Address - Phone:860-875-4816
Practice Address - Fax:860-875-2053
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003038CT01OtherBLUE CROSS PROVIDER NUMBE
CT552280OtherAETNA GROUP NUMBER
CTA685551OtherOXFORD GROUP NUMBER
CTOV1704OtherHEALTHNET GROUP NUMBER