Provider Demographics
NPI:1962925859
Name:MULREADY, MEGAN (ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MULREADY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W MAIN ST APT 3023
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-9090
Mailing Address - Country:US
Mailing Address - Phone:510-295-8193
Mailing Address - Fax:
Practice Address - Street 1:2121 W MAIN ST APT 3023
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-9090
Practice Address - Country:US
Practice Address - Phone:510-295-8193
Practice Address - Fax:510-295-8193
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028489OtherBOARD OF CERTIFICATION ATHLETIC TRAINING