MEDICARE: THOMAS MULLIGAN PT, ATC, CSCS

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	2251S0007X	Sports Physical Therapist	PT23678	FL
2	2255A2300X	Athletic Trainer	AL1418	FL

General Provider Information

NPI Number	:	1134643356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MULLIGAN PT, ATC, CSCS

Provider Business Mailing Address
First Line	:	10276 ESTUARY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 CHANNELSIDE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5400
Country	:	US
Telephone Number	:	813-301-6793
Fax Number	:

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

Provider Enumeration Date	:	07/29/2017
Last Update Date	:	07/29/2017

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