Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT23678 | FL |
NPI | 1134643356 |
---|---|
Provider Name | Thomas Mulligan |
First Address | Tampa, FL 33647-3123 |
Second Address | Tampa, FL 33602-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2017 |
Last Update Date | 29/07/2017 |