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4004 W 111th St, Oak Lawn, IL 60453-5703 | |
(708) 424-4025 | |
(708) 424-4591 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 4004 W 111th St, Oak Lawn, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043384761 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (Illinois) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Thomas G Mulvey |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1528285681 PECOS PAC ID: 3779734082 Enrollment ID: I20121115000580 |
Mailing Address | Practice Location Address |
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4004 W 111th St, Oak Lawn, IL 60453-5703 Ph: (708) 424-4025 | 4004 W 111th St, Oak Lawn, IL 60453-5703 Ph: (708) 424-4025 |