Provider Demographics
NPI:1043384761
Name:THOMAS G. MULVEY , M.S., P.T., M.B.A., P.C.
Entity Type:Organization
Organization Name:THOMAS G. MULVEY , M.S., P.T., M.B.A., P.C.
Other - Org Name:ATHLETEX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT MBA
Authorized Official - Phone:708-424-4025
Mailing Address - Street 1:4004 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5703
Mailing Address - Country:US
Mailing Address - Phone:708-424-4025
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty