MEDICARE: BRANDON JAMES MULROONEY PT DPT

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	301239	CA

General Provider Information

NPI Number	:	1619628153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON JAMES MULROONEY PT DPT

Provider Business Mailing Address
First Line	:	408 HIGUERA ST STE 200
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6135
Country	:	US
Telephone Number	:	805-788-0805
Fax Number	:	805-788-0845

Provider Business Practice Location Address
First Line	:	835 C ST STE 250
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-2800
Country	:	US
Telephone Number	:	209-745-5802
Fax Number	:	209-745-5574

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

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	12/11/2025

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