Provider Demographics
NPI:1033431606
Name:MAHONEY, PATRICIA (RPT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WOODWARD AVE
Mailing Address - Street 2:UNIT 27
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-5038
Mailing Address - Country:US
Mailing Address - Phone:203-469-1833
Mailing Address - Fax:
Practice Address - Street 1:318 NEW HAVEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6661
Practice Address - Country:US
Practice Address - Phone:203-874-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist