MEDICARE: MICHAEL PATRICK MULRYAN PT

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	14.014710	CT

General Provider Information

NPI Number	:	1548076300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PATRICK MULRYAN PT

Provider Business Mailing Address
First Line	:	336 STATE ST STE 3
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3170
Country	:	US
Telephone Number	:	203-745-4973
Fax Number	:	203-821-7417

Provider Business Practice Location Address
First Line	:	336 STATE ST STE 3
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3170
Country	:	US
Telephone Number	:	203-745-4973
Fax Number	:	203-821-7417

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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