MEDICARE: DR. ELIZABETH (LIZANNE) ANN MULLIGAN PT, PHD

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	002576	OH

General Provider Information

NPI Number	:	1760607303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH (LIZANNE) ANN MULLIGAN PT, PHD

Provider Business Mailing Address
First Line	:	1496 EBENEZER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45233-4953
Country	:	US
Telephone Number	:	513-558-7482
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 EDEN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0001
Country	:	US
Telephone Number	:	513-558-7482
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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