Provider Demographics
NPI:1164916334
Name:MULVEY, SIOBHAN MARY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:MARY
Last Name:MULVEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Practice Address - Street 1:11140 W 179TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9435
Practice Address - Country:US
Practice Address - Phone:708-478-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist