MEDICARE: MR. JAMES OWEN MULROY DPT

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	2305202490	VA
2	2251X0800X	Orthopedic Physical Therapist	8447	AZ
3	225100000X	Physical Therapist	P22685	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305202490	OTHER	VA	PT LICENSE
2	P22685	OTHER	NC	PT LICENSE

General Provider Information

NPI Number	:	1659315703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES OWEN MULROY DPT

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	910-332-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6419 CAROLINA BEACH RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-3671
Country	:	US
Telephone Number	:	910-332-3800
Fax Number	:	910-251-0421

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/21/2024

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