Provider Demographics
NPI:1326670548
Name:MULLIGAN, COLIN MICHAEL SZABO (ATC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:MICHAEL SZABO
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3093 MAIN ST APT 324
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-2128
Mailing Address - Country:US
Mailing Address - Phone:559-396-5794
Mailing Address - Fax:
Practice Address - Street 1:236 KERR ADMINISTRATION BLDG
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8578
Practice Address - Country:US
Practice Address - Phone:559-396-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBOC1538302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer