Provider Demographics
NPI:1821164211
Name:MULLIGAN, EDWARD PATRICK (PT, DPT, OCS, SCS, A)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PATRICK
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:PT, DPT, OCS, SCS, A
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:817-739-8481
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8876
Practice Address - Country:US
Practice Address - Phone:214-648-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1032399OtherLICENSE#