Individual
DESTINEE MULLINIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1105 VILLAGE RD, NEOSHO, MO 64850-9076
(800) 381-0822
(352) 565-5201
Mailing address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(800) 381-0822
(352) 565-5201
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2018026836
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018026836
PTA
MO
Enumeration date
02/13/2019
Last updated
03/03/2025
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