Provider Demographics
NPI:1790914471
Name:MULLIGAN, DANA HEATHER (LMT)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:HEATHER
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4451
Mailing Address - Country:US
Mailing Address - Phone:352-871-2892
Mailing Address - Fax:
Practice Address - Street 1:7733 W NEWBERRY RD
Practice Address - Street 2:SUITE B1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9245
Practice Address - Country:US
Practice Address - Phone:352-332-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 50692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist