Healthcare Provider Details

I. General information

NPI: 1043384761
Provider Name (Legal Business Name): THOMAS G. MULVEY , M.S., P.T., M.B.A., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 W 111TH ST
OAK LAWN IL
60453-5703
US

IV. Provider business mailing address

4004 W 111TH ST
OAK LAWN IL
60453-5703
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-4025
  • Fax: 708-424-4591
Mailing address:
  • Phone: 708-424-4025
  • Fax: 708-424-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS GERARD MULVEY
Title or Position: OWNER
Credential: MS PT MBA
Phone: 708-424-4025