Provider Demographics
NPI:1528285681
Name:MULVEY, THOMAS G (MS, PT, MBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:G
Last Name:MULVEY
Suffix:
Gender:M
Credentials:MS, PT, MBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14148 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2019
Mailing Address - Country:US
Mailing Address - Phone:708-460-0095
Mailing Address - Fax:708-424-4591
Practice Address - Street 1:4004 W 111TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5703
Practice Address - Country:US
Practice Address - Phone:708-424-4025
Practice Address - Fax:708-424-4591
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist