MEDICARE: BEVERLY ANN MCNULTY

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	1204250

General Provider Information

NPI Number	:	1225512221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY ANN MCNULTY

Provider Business Mailing Address
First Line	:	219 ROCK RIDGE RD
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-8025
Country	:	US
Telephone Number	:	504-415-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 BARNETT DR
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3176
Country	:	US
Telephone Number	:	972-317-1174
Fax Number	:

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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Directions to “ BEVERLY ANN MCNULTY ” Practice Location

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