MEDICARE: KATY LYNN MULFORD PTA

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	225200000X	Physical Therapy Assistant	A7476	NC

General Provider Information

NPI Number	:	1093384216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY LYNN MULFORD PTA

Provider Business Mailing Address
First Line	:	60 RODNEY CT
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-8512
Country	:	US
Telephone Number	:	909-735-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 EDINBURGH SOUTH DR STE 106
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-6484
Country	:	US
Telephone Number	:	919-785-9356
Fax Number	:

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

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/23/2021

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