Healthcare Provider Details

I. General information

NPI: 1477280758
Provider Name (Legal Business Name): NATALIE MULLIGAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 MANCHESTER RD
SAINT LOUIS MO
63122-1253
US

IV. Provider business mailing address

11135 MANCHESTER RD
SAINT LOUIS MO
63122-1253
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2022029381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: