MEDICARE: MRS. NANCY K MULLIGAN P.T.

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	2251G0304X	Geriatric Physical Therapist	1335	NV
2	2251P0200X	Pediatric Physical Therapist	1335	NV
3	2251X0800X	Orthopedic Physical Therapist	1335	NV

General Provider Information

NPI Number	:	1619102803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY K MULLIGAN P.T.

Provider Business Mailing Address
First Line	:	505 E WINDMILL LN
Second Line	:	STE 1B (255)
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1869
Country	:	US
Telephone Number	:	702-592-1704
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 E WINDMILL LN
Second Line	:	STE 1B (255)
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1869
Country	:	US
Telephone Number	:	702-592-1704
Fax Number	:

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

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/18/2009

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