Active NPI
Michael Patrick Mulryan, PT
- Physical Therapist
- Fair Lawn, NJ
National Provider Identifier
1548076300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA02413300
- Practice address
- 2-22 Banta PL
Fair Lawn, NJ 07410-3058 - Phone
- (877) 532-7837
- NPI assigned
- Dec 6, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA02413300 | NJ | Primary |
Addresses
Primary practice location
2-22 Banta PL
Fair Lawn, NJ 07410-3058
Mailing address
1455 Broad St Ste 250
Bloomfield, NJ 07003-3066
Phone (877) 532-7837
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
525 Hwy 35
Red Bank, NJ 07701-5037
Phone (848) 216-0765
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA02413300 | NJ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revive Therapy LLC | Physical Therapist | Current | Accepting new patients |
Locations
336 State St
Ste 3
North Haven, CT 06473
Phone (203) 980-8166
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Bloomfield, NJ
- NPI 1275286148
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778544000000",
"number": "1548076300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1455 BROAD ST STE 250",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033066",
"telephone_number": "877-532-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2-22 BANTA PL",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074103058",
"telephone_number": "877-532-7837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULRYAN",
"first_name": "MICHAEL",
"middle_name": "PATRICK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-12-06",
"last_updated": "2026-05-12",
"certification_date": "2026-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA02413300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Lawn, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.