Healthcare Provider Details

I. General information

NPI: 1013482827
Provider Name (Legal Business Name): JENNIFER MARIE MULLIGAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 FAMILY PL
COLORADO SPRINGS CO
80920-7807
US

IV. Provider business mailing address

9070 W CHEYENNE AVE STE 100
LAS VEGAS NV
89129-8935
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-4415
  • Fax: 719-547-2487
Mailing address:
  • Phone: 702-818-5000
  • Fax: 702-818-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0051979
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: