Provider Demographics
NPI:1730575341
Name:MCMULLEN, LAURA JEANNNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LAURA JEANNNE
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19285 DAVID MEMORIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8778
Mailing Address - Country:US
Mailing Address - Phone:936-321-8300
Mailing Address - Fax:
Practice Address - Street 1:19285 DAVID MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8778
Practice Address - Country:US
Practice Address - Phone:936-321-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2014742225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant