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Individual

MRS. JUSTINE MCCORMICK MULLINNIX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
2006 PELHAM RD, GREENVILLE, SC 29615-4005
(877) 648-1197
Mailing address
1011 W BUTLER RD APT 412, GREENVILLE, SC 29607-4814
(803) 968-0045

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3432
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3432
SC LLR
SC
Enumeration date
11/19/2015
Last updated
11/19/2015
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