MEDICARE: MS. MARYKATE HORRIGAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0099401	NY

General Provider Information

NPI Number	:	1063410025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYKATE HORRIGAN P.T.

Provider Business Mailing Address
First Line	:	552 VALLEY RD
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1805
Country	:	US
Telephone Number	:	973-509-0827
Fax Number	:	973-509-0877

Provider Business Practice Location Address
First Line	:	552 VALLEY RD
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1805
Country	:	US
Telephone Number	:	973-509-0827
Fax Number	:	973-509-0877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/27/2021

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