Provider Demographics
NPI:1619102803
Name:MULLIGAN, NANCY K (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:K
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 1:505 E WINDMILL LN
Mailing Address - Street 2:STE 1B (255)
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1869
Mailing Address - Country:US
Mailing Address - Phone:702-592-1704
Mailing Address - Fax:
Practice Address - Street 1:505 E WINDMILL LN
Practice Address - Street 2:STE 1B (255)
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1869
Practice Address - Country:US
Practice Address - Phone:702-592-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13352251G0304X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic