Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1629 | AZ |
NPI | 1043220148 |
---|---|
Provider Name | Kevin Patrick Mahon |
First Address | Tucson, AZ 85745-2687 |
Second Address | Tucson, AZ 85749-9610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 04/05/2015 |