Provider Demographics
NPI:1962629287
Name:THOMAS G. MULVEY , M.S., P.T., M.B.A., P.C.
Entity Type:Organization
Organization Name:THOMAS G. MULVEY , M.S., P.T., M.B.A., P.C.
Other - Org Name:ATHLETEX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-424-4025
Mailing Address - Street 1:11140 W 179TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9435
Mailing Address - Country:US
Mailing Address - Phone:708-478-7226
Mailing Address - Fax:708-478-7229
Practice Address - Street 1:11140 W 179TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9435
Practice Address - Country:US
Practice Address - Phone:708-478-7226
Practice Address - Fax:708-478-7229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHLETEX PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325950Medicare ID - Type Unspecified