Provider Demographics
NPI:1922174184
Name:MULDOON, MICHAEL THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:MULDOON
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:7 GLOUCESTER CROSSING ROAD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-816-2526
Mailing Address - Fax:
Practice Address - Street 1:152 CONANT ST STE 301
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1659
Practice Address - Country:US
Practice Address - Phone:978-927-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15754225100000X
NH3003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist