Provider Demographics
NPI:1114103165
Name:MULLIGAN, JANA HOGG (PT)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:HOGG
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PINTAIL PKWY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2183
Mailing Address - Country:US
Mailing Address - Phone:817-233-4764
Mailing Address - Fax:817-684-7201
Practice Address - Street 1:5060 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7004
Practice Address - Country:US
Practice Address - Phone:817-498-8585
Practice Address - Fax:817-498-8582
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist