Provider Demographics
NPI:1316954795
Name:MULLIGAN, BRIAN A (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2609
Mailing Address - Country:US
Mailing Address - Phone:609-203-6272
Mailing Address - Fax:
Practice Address - Street 1:11 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2609
Practice Address - Country:US
Practice Address - Phone:609-203-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA08654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092608Medicare ID - Type Unspecified