Most Relevant Information
Provider Data
| NPI Number: | 1003547415 |
| Provider Name: | MICHAEL JOSEPH MULLAN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 160.009578 |
Most Important Dates
| Enumeration Date: | 06/17/2022 |
| Last Updated: | 06/17/2022 |
Provider Practice Location
20201 CRAWFORD AVE
OLYMPIA FIELDS
IL
604611010
Practice Location Phone/Fax
| Phone: | 7088522540 |
| Fax: |
Provider Mailing Location
20201 CRAWFORD AVE
OLYMPIA FIELDS
IL
604611010
Provider Mailing Phone/Fax
| Phone: | 7088522540 |
| Fax: | 7085033221 |